Syphilitic Retinitis

A 48-Year-Old Caucasian Man With Unilateral “Smudge” in Inferior Visual Field

“…5 However, there have been an increasing number of reports of syphilis patients, especially in the population of men who have sex with men, who present with fundus findings similar to acute retinal necrosis, as was observed in our patient. 5,6 These findings include a characteristic ground glass, translucent appearance of unifocal or multifocal lesions, primarily affecting the inner retina and sometimes associated with colocalizing occlusive vasculitis. 5–8 Although these syphilitic lesions have previously been described as wedge-shaped, the leading or brushfire-type edge, which was noted in our patient and frequently occurs in CMV retinitis, is less common in syphilis.…”

“…5,6 These findings include a characteristic ground glass, translucent appearance of unifocal or multifocal lesions, primarily affecting the inner retina and sometimes associated with colocalizing occlusive vasculitis. [5][6][7][8] Although these syphilitic lesions have previously been described as wedge-shaped, the leading or brushfire-type edge, which was noted in our patient and frequently occurs in CMV retinitis, is less common in syphilis. 7 Another interesting feature of syphilitic retinitis is that it heals with minimal disruption of the underlying RPE.…”

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 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.…”

Optic Disc Edema in Syphilis

“…An ischemic mechanism of optic nerve edema in patients with syphilitic optic neuropathy is also possible if syphilisinduced vasculitis involves posterior ciliary arteries supplying the optic nerve head. In the retina where vessels are more readily imaged using fundus photography and fluorescein angiography, a wide spectrum of retinal vasculitis secondary to syphilis has been described with perivascular inflammatory infiltrates causing arterial narrowing, thrombosis, and occlusion (12)(13)(14).…”