Ocular syphilis revisited: a review of cases and evidence from the literature

Abstract

Aim: this case series seeks to share our experience with ocular syphilis by reporting the clinical findings and management of nine diagnosed cases.Materials and methods: this retrospective case series comprises nine patients who presented to the Ophthalmology Department of Southampton General Hospital between 2013 and 2022. The series provides a comprehensive report on patients diagnosed with ocular syphilis, detailing the severity of the condition, associated symptoms, and the treatments administered.Results: all cases in the study were diagnosed with syphilis based on ocular findings. The patients exhibited a wide range of visual acuity, from normal to as low as light perception vision, with corresponding posterior segment results and varied intraocular pressure data. Some patients had recently been diagnosed with co-infection involving the human immunodeficiency virus. Except for one patient who underwent intravenous ceftriaxone treatment, the majority received systemic therapy with intravenous benzylpenicillin. In four cases, prednisolone was administered in conjunction with the systemic treatment. For topical therapy, three patients were provided with cycloplegics and topical steroids to alleviate discomfort and prevent iris adhesions.Conclusions: diagnosing ocular syphilis presents challenges, which emphasizes the value of excluding syphilis infection in patients exhibiting uveitis, optic nerve neuritis or atrophy, acute muscular palsy, or visual loss. Ocular syphilis warrants consideration during diagnosis, necessitates treatment akin to neurosyphilis, and mandates testing for other immunodeficiency diseases. Inadequate management may lead to persistent vision impairment