Ocular uveitis as the initial presentation of syphilis.

BACKGROUND To document the characteristics of syphilitic patients who present with ocular uveitis clinically and are diagnosed by an ophthalmologist first. METHODS Retrospective chart review of uveitis patients in the department of ophthalmology between 1992 and 2004 was done. We included only those patients with positive serologic tests, active ocular uveitis, and record of detailed examination. RESULTS There were 8 syphilitic patients (14 eyes) who presented with ocular syphilis clinically and who were diagnosed by an ophthalmologist first. The ocular diagnosis included panuveitis (11 eyes, 78.6%), anterior uveitis (2 eyes, 14.3%), and posterior uveitis (1 eye, 7.1%). Two patients (25%) had unilateral eye involvement, and 6 patients (75%) had involvement in bilateral eyes. One patient (2 eyes) with panuveitis also had bilateral exudative retinal detachment and chronic angle closure glaucoma. All 8 patients were negative for human immunodeficiency virus. Dark field examination of aqueous humor in 2 cases revealed Treponema pallidum, which was confirmed by immunofluorescent test. Treatment included systemic penicillin in 7 patients and oral tetracycline in 1 patient (due to penicillin allergy). Visual function and uveitis improved after treatment in all patients. CONCLUSION Syphilis can be presented initially as ocular uveitis without obvious systemic manifestation. Ophthalmologists play an important role in the early diagnosis and treatment of syphilis. If treated early enough, the response is good, even if the patient is allergic to penicillin. Awareness of the multiple manifestations of ocular syphilis is the key to early detection of the disease.