Adult-Onset Syphilitic Stromal Keratitis

Unilateral solitary choroidal granuloma as presenting sign of secondary syphilis

“…However, syphilis should remain an important consideration for many types of ocular inflammation because of its protean manifestations. They include disease of the cornea and ocular surface, posterioruveitis, optic nerve involvement, retinal vascular disease, retinal detachments, and others [1][2][3][4][5][6].Ocular syphilis remains a highly treatable illness, with intravenous penicillin G or intramuscular penicillin being the hallmarks of therapy [7]. We report two cases of syphilis presenting as solitary granulomas, to emphasize the relevance of consideration of this illness early in the diagnostic investigation for similar ocular signs.…”

Ophthalmic Consequences of Syphilis

“…1). In congenital syphilis, it commonly presents as bilateral stromal keratitis, but in acquired cases, it may present as a unilateral, nonulcerative, infiltrative keratitis with paracentral stromal edema and possible corneal neovascularization 49. A retrospective report found that the majority of unilateral active IK cases were due to herpes simplex virus, while 48.5% of bilateral inactive cases were due to syphilis 50.…”

“…In congenital syphilis, it commonly presents as bilateral stromal keratitis, but in acquired cases, it may present as a unilateral, nonulcerative, infiltrative keratitis with paracentral stromal edema and Necrotizing retinitis 37 Preretinal infiltrates 38 Exudative retinal detachment 39 Vasculitis 40,41 Pigmentary retinopathy 42 Central nervous system Pupils -Argyll-Robertson (miotic, irregular with light-near dissociation) 43,44 Argyll-Robertson 45 Extraocular movement -Cranial nerve palsies: CN3, CN4, CN6 Superior orbital fissure syndrome 46 Supranuclear gaze palsy 47 possible corneal neovascularization. 49 A retrospective report found that the majority of unilateral active IK cases were due to herpes simplex virus, while 48.5% of bilateral inactive cases were due to syphilis. 50 Importantly, syphilitic IK requires corticosteroid therapy as it appears to be an immunologic phenomenon directed against treponemal antigens deposited in the cornea.…”

Augenbeteiligung bei venerischer Syphilis – Update

“…Hinweisend ist der granulomatöse Charakter der Entzündung [23]. Im Zusammenhang mit Syphilis wurde eine immunvermittelte, nicht nekrotisierende interstitielle Keratitis beobachtet, die zu stromaler Narbenbildung und tiefer Neovaskularisierung (später Ghost Vessels) führen kann [24,25]. Die interstitielle Keratitis kann auch das initiale klinische Zeichen einer reaktivierenden Syphilis sein [26].…”