Ocular syphilis presents widely from conjunctivitis to vasculitis and can involve any portion of the eye. However, optic nerve involvement is a rare manifestation. Noticeably, with the increase in syphilis cases in various countries, there has also been an increase in the number of ocular syphilis patients. The primary objective is to present a case of ocular syphilis manifesting as optic disc edema.
This is a case of a young, immunocompetent Filipino male presenting with 5 day history of blurring of vision and eye pain of both eyes, starting with the left eye. A complete Neuro-ophthalmologic examination was conducted. Diagnostics such as visual field perimetry, optical coherence tomography, and magnetic resonance imaging of the brain and orbits were done. Other diagnostics to work-up for infectious and auto-immune diseases were also included.
The patient presented with sudden blurring of vision of both eyes, initially on the left and an RAPD on the left. On fundoscopy, using the modified Frisen scale, he had grade 5 and grade 4 disc edema on the right and left eye, respectively. Perimetry revealed generalized depressions of both eyes. Magnetic resonance imaging revealed hyperintensity and enhancement of the left optic nerve. He was positive for both RPR and FTA-ABS and was diagnosed to have syphilitic optic neuritis. He underwent desensitization to and completed 10 days of penicillin treatment with improvement in visual acuity and disc edema.
Timely treatment of syphilis has a good prognosis, though delayed diagnosis and administration of antibiotics may have permanent visual consequences for patients. This case emphasizes the importance of having a high index of suspicion of possible syphilis infection for inflammatory eye conditions to prevent poor visual outcomes.