Resurgence of Acquired Syphilitic Uveitis: Characteristics, Challenges and Outcomes

Syphilitic uveitis (SU) is a re-emerging cause of intraocular inflammation. This study aimed to characterize the clinical, imaging features, treatment modalities, and outcomes of SU at a tertiary-care center in North India over the last decade.

A retrospective observational study included SU patients between January 2016 and April 2025. Diagnosis was based on compatible clinical features, positive syphilis serology, and response to antibiotic therapy. Data on demographics, HIV status, ocular findings, imaging, treatment regimens, and outcomes were retrieved. Best-corrected visual acuity (BCVA) was assessed, with favorable outcome defined as BCVA ≥20/30. Statistical analysis identified factors associated with favorable outcome.

Twenty-six patients (44 eyes) were included, predominantly male (92.3%) with mean age being 37.9 ± 12.1 years. Five patients presented before and 21 presented after Coronavirus disease (COVID-19) pandemic. HIV co-infection was present in 50% of patients. Posterior uveitis (61.4%) and panuveitis (36.4%) were common forms. Characteristic placoid or confluent chorioretinitis patterns were noted, with punctate white dots in nearly one-third of eyes. 38.5% cases were misdiagnosed initially and empirically treated with corticosteroids. Definitive treatment included intravenous ceftriaxone or aqueous penicillin with adjunctive corticosteroids in few cases. At median follow-up of 9-months, 93.2% eyes showed resolution, and 54.5% achieved BCVA ≥20/30. Better initial vision, posterior uveitis (versus. panuveitis), and treatment with aqueous penicillin were associated with favorable outcome.

Syphilitic uveitis has resurged, particularly in the post-COVID era. Heightened awareness, due suspicion, and early recognition using multimodal imaging are vital for favorable outcomes. Aqueous penicillin may yield superior outcomes and merits further evaluation.