Ocular Syphilis Update

Congenital ocular syphilis causes chorioretinitis, iritis, dacryocystitis, and interstitial keratitis. Syphilitic uveitis, stromal keratitis, scleritis, and optic neuritis develop after the second stage of acquired ocular syphilis, and gummas of the eyelids and Argyll Robertson pupil are seen in the third stage. In syphilitic uveitis, vitreous opacity, multifocal choroiditis, retinal vasculitis, and acute syphilitic posterior placoid chorioretinitis are seen, and because of the variety of ocular findings, a serologic test for syphilis is the key to accurate diagnosis. Although not widely recognized, scleritis can also occur, and syphilis should also be suspected in intractable scleritis. A multiplex polymerase chain reaction procedure that uses intraocular fluid is helpful in the diagnosis of ocular syphilis because the ocular findings become complicated when they overlap with a human immunodeficiency virus infection or reinfection. Since most cases of ocular syphilis are associated with neurosyphilis, the guidelines proposed by the U.S. Center for Disease Control encourage treatment in accordance with neurosyphilis. The prognosis for visual acuity is good; however, early diagnosis is important. If optic nerve manifestations, which may affect visual acuity, are suspected, a cerebral spinal fluid examination should be performed as soon as possible for early diagnosis and treatment.