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Clinical Reasoning: A 58-Year-Old Woman With Painless Blurry Vision
Christian Diaz Curbelo1, Peter Weseley2, Steven L Galetta2,3
1NYU Grossman School of Medicine.
Neurology
|June 18, 2026
Summary
A woman experienced vision loss due to optic nerve swelling and uveitis. Diagnostic tests revealed syphilis, highlighting the importance of considering syphilis in neuro-ophthalmic cases.
Area of Science:
- Ophthalmology
- Neuro-ophthalmology
- Infectious Diseases
Background:
- Bilateral optic nerve edema and uveitis can present with various etiologies.
- Differentiating between infectious and autoimmune causes is critical for appropriate management.
- Neuro-ophthalmic presentations require a comprehensive diagnostic approach.
Purpose of the Study:
- To present a case of bilateral optic nerve edema and uveitis.
- To discuss the differential diagnosis of this neuro-ophthalmic presentation.
- To explore challenges in interpreting diagnostic tests for syphilis in this context.
Main Methods:
- Case presentation of a 58-year-old woman with visual disturbances.
- Ophthalmic examination including visual acuity and fundoscopy.
- Neuroimaging (MRI) and laboratory investigations including serum and cerebrospinal fluid (CSF) analysis for infectious etiologies.
Main Results:
- The patient presented with bilateral blurred vision, optic nerve edema, anterior uveitis, and retinal hemorrhages.
- MRI showed optic nerve enhancement.
- Serological tests were positive for *Treponema pallidum* (syphilis) with a high RPR titer, despite a negative Lyme disease test.
- CSF analysis showed mild lymphocytic pleocytosis.
Conclusions:
- Syphilis should be considered in the differential diagnosis of bilateral optic nerve edema and uveitis, even with atypical presentations.
- Interpreting diagnostic tests for syphilis in neuro-ophthalmic conditions requires careful clinical correlation.
- Prompt diagnosis and treatment of neurosyphilis are crucial to prevent irreversible vision loss.
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