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Ocular syphilis - External and Internal Eye
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Ocular syphilis - External and Internal Eye

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Contributors: Brandon D. Ayres MD, Christopher Rapuano MD, Harvey A. Brown MD, Sunir J. Garg MD, Lauren Patty Daskivich MD, MSHS
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Synopsis

Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum (a spirochete) and is characterized by a chronic intermittent clinical course. Treponema pallidum is transmitted person to person via direct contact with a syphilis ulcer during vaginal, anal, or oral sex and may enter through skin or mucous membranes. Ocular syphilis is a less common but serious manifestation of T. pallidum infection. Literally all structures of the eye may be involved by syphilis, with presentation dependent on the structures involved. Whether it be conjunctivitis, scleritis, episcleritis, keratitis, glaucoma, ocular motility disturbances, ptosis, pupillary changes, lens dislocation, uveitis, vitritis, chorioretinitis, or optic atrophy, syphilis can be devastating to ocular structures and functions. Worse yet, some ocular manifestations may occur years after initial involvement.
 
Ocular syphilis can be congenital or acquired. Congenital syphilis, despite its relative rarity, still poses a very significant and real threat to the eye. Acquired ocular syphilis can affect any individual; however, in the United States, it most commonly affects men. In a Centers for Disease Control and Prevention (CDC) 2014-15 survey, more than half of the identified cases involved men who have sex with men, and 51% involved human immunodeficiency virus (HIV)-positive patients.

Related topics: Primary syphilis, Secondary syphilis, Neurosyphilis, Early and Late congenital syphilis

Codes

ICD10CM:
A51.43 – Secondary syphilitic oculopathy

SNOMEDCT:
410478005 – Ocular syphilis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

As most medical students learn, syphilis is a great masquerader. Cytomegalovirus infection, AIDS, toxoplasmosis, candidal endophthalmitis, Behçet disease, sarcoidosis, reticulum cell sarcoma in elderly patients, and HLA-B27 syndromes are all in the differential for syphilis. What is worse is that some of these can coexist with syphilis present. History and lab testing is critical to the process of diagnosis.

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated: 04/18/2018
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Ocular syphilis - External and Internal Eye
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Ocular syphilis : Eye pain, Blurred vision, Photophobia, Floaters, Conjunctival injection, Intravenous drug abuse
Clinical image of Ocular syphilis
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