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Benjamin Butet, Stéphanie Baillif; Ocular manifestations of syphilis: an eight-year restrospective study in southern France. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3137.
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Over the last decade, there is a trend for increasing frequency of syphilis in developed countries. Prompt recognition of syphilitic uveitis is essential. The purpose of this study is to describe the ocular manifestations of syphilis and its outcome.
A retrospective, observational, non comparative review of clinical records was performed. Every treponemal and non treponemal serologies performed at the Nice University Hospital from november 2005 to october 2013 were collected. Cases with documented syphilis infection and ocular involvement were reviewed over that period. Collected data included clinical ophthalmologic features (visual acuity, slit lamp and fundus), complementary examinations, treatment and follow-up.
51 patients had active syphilis infection over that period. Eleven patients were diagnosed with syphilitic uveitis (21%). Ocular inflammation led to the diagnosis of syphilis in 9 patients (81.8%).<br /> Clinical features were bilateral for 9/11 patients (81.8%) and characterized by papillitis (10 patients ; 90.9%) which was isolated in 3 cases, and part of a panuveitis for 7 patients (63.6%). Panuveitis exhibited vitreous inflammation (100%), venous vasculitis (57.1%), posterior placoid choroiditis (42.8%) multifocal choroiditis (14.2%), vitreous hemorrhage (28.5%), associated with inflammation of the anterior segment (71.4%).<br /> Isolated anterior granulomatous uveitis was found in one patient (9%). Initial mean visual acuity was 20/40 (range: 20/20 to “light perception”) and 20/25 at last visit. HIV co-infection was diagnosed in 3 patients (27.2%). A lumbar puncture found a central nervous system infection in 7 patients (63.6%).
Posterior bilateral uveitis was the most common ophthalmologic manifestation of syphilis. Anatomical and functional ocular prognosis was good after appropriate antibiotic therapy. Syphilis should still be considered in the differential diagnosis of ocular inflammation. An HIV co-infection should be searched for.
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