The incidence of syphilis infection has increased by more than 150% over the past decade. Although ocular syphilis affects only a small percentage of patients with syphilis, cases of syphilitic uveitis are increasing in the UK. Ocular signs may be the first signs of disease, therefore early recognition and prompt treatment is crucial in prevention of irreversible visual loss.
Two serologically proven cases of ocular syphilis were reviewed retrospectively
Case 1; a 40 year old male patient presented with a 2 week history of bilateral ocular pain and reduced vision. On examination, visual acuity was 6/18 in both eyes, and clinical signs were suggestive of bilateral panuveitis. Immediate serological testing was positive for Syphilis. A diagnosis of syphilitic uveitis was made with referral to GUM clinic. Improvement in visual acuity was noted following commencement on treatment. Case 2; a 78 year old male patient presented with a 1 week history of left eye pain and reduced vision. At presentation, visual acuity was 6/24 in the left eye, and signs were consistent with left acute anterior uveitis. His vision then deteriorated and he was subsequently seen with severe panuveitis which, due to a co-existing diagnosis of prostate cancer, was investigated as a possible uveitis masquerade syndrome causing a delay in Syphilis testing. 3 months post presentation, serological testing was confirmatory for Syphilis. Following treatment, visual acuity improved to 6/9, however, he continues to require treatment for recurrent episodes of posterior uveitis.
In the face of a resurgence of syphilis cases in the UK, our cases highlight the importance of maintaining a low index of suspicion for syphilis, with prompt serological testing to avoid treatment delays and prevent adverse visual outcomes