Acute choroido-retinitis in secondary syphilis. Presence of spiral organisms in the aqueous humour.

The importance of syphilis as a cause of eye disease has been appreciated since the discovery of the relationship between interstitial keratitis, uveitis, and congenital syphilis by Jonathan Hutchinson in the middle of the 19th century (Hutchinson, 1858). Many years ago Moore (1931) made a plea for a greater awareness of syphilis as a cause of uveitis and reported that 4-6 per cent. of patients with early secondary syphilis had iritis; in recurrent secondary syphilis the incidence was as high at 9 3 per cent. Guyton and Woods (1941), in Baltimore, considered that 59 (10.5 per cent.) of a series of 562 cases of uveitis were due to syphilis, of which 22 were congenital and 37 acquired. Perkins (1961), however, found that only 1-2 per cent. of 1,718 cases of uveitis seen in London were due to this cause. The incidence of intraocular inflammation in patients with early infectious syphilis is obviously variable in different areas of the world, and Duke-Elder and Perkins (1965) are of the opinion that the incidence varies from 3 to 15 per cent. The diagnosis of anterior uveitis in secondary syphilis can usually be made with reasonable certainty on clinical grounds and the condition responds rapidly to antisyphilitic treatment. The diagnosis of other ocular lesions in early infectious syphilis is less certain and is frequently open to doubt. For this reason and because infectious syphilis is a comparatively rare cause of acute choroido-retinitis (Blodi and Hervouet, 1968; Rice, Jones and Wilkinson, 1968; King and Nicol, 1969), we think the following case may be of interest.