Syphilis is a significant health concern that may impact multiple organs. Understanding how syphilis affects the eyes is crucial because it may aid in early detection, treatment, and prevention of serious complications such as blindness.
Learn the characteristics of syphilis eyes, diagnostic methods, treatments, and preventive measures here.
What is Syphilis?
Syphilis is a bacterial infection caused by the bacterium Treponema pallidum. The spread of the infection happens mainly through sexual contact.
Syphilis develops in stages, each with distinct symptoms:
Primary Syphilis: Painless sores (chancres) at the infection site.
Secondary Syphilis: Skin rashes, mucous membrane lesions, fever, swollen lymph nodes, sore throat.
Latent Syphilis: A symptom-free period where the bacteria remains in the body.
Tertiary Syphilis: May occur years after the initial infection, affecting the heart, brain, nerves, liver, and eyes.
How Syphilis Affects the Eyes?
Ocular syphilis refers to any involvement of the eyes due to syphilis infection. The syphilis eye infection can occur at any stage. However, it is often associated with secondary and tertiary stages.
Treponema pallidum invades ocular tissues through the bloodstream, causing inflammation and damage.
The bacteria can affect various parts of the eye. For example, the retina, optic nerve, and uveal tract. The infection can also trigger inflammation of the cornea and conjunctiva.
Ocular syphilis can have serious complications, even permanent blindness from syphilis if not treated on time.
Syphilis Eye Symptoms
Patients with ocular syphilis may present with a range of symptoms. The warning signs may vary, often depending on which part of the eye is affected.
Common symptoms to look out for include:
Blurred vision
Eye pain
Redness
Sensitivity to light
Floaters (small spots drifting across your field of vision)
Visual field defects
Sudden vision loss
These symptoms are NOT exclusive to syphilis and may also suggest other eye conditions. Please consult an ophthalmologist for an accurate diagnosis if you have concerns.
Diagnosis of a Syphilis Eye Infection
Early diagnosis of ocular syphilis may prevent permanent damage to the eyes. Holding off an examination, testing, and diagnosis is only going to increase the risks.
The process of finding out if you have eyes with syphilis involves a series of clinical evaluations, lab tests, and imaging.
Clinical Evaluation
Ophthalmologists will perform an eye examination, including:
Visual acuity test
Slit-lamp examination
Fundoscopy to examine the retina and optic nerve
Measurement of intraocular pressure
Laboratory Tests
To confirm the infection, the relevant lab tests include:
Rapid Plasma Reagin (RPR)
Venereal Disease Research Laboratory (VDRL)
Fluorescent Treponemal Antibody Absorption (FTA-ABS)
Treponema pallidum particle agglutination assay (TPPA)
These bloodwork and lab tests detect antibodies specific to the syphilis bacterium.
Ophthalmology Imaging Studies
In some cases, imaging studies help assess the extent of retinal and optic nerve involvement in eyes with syphilis.
The imaging tests to confirm or deny a syphilis diagnosis are:
Optical coherence tomography (OCT)
Fluorescein angiography
OCT is a non-invasive method of capturing high-resolution cross-sectional images of the retina. It works by projecting light into the eye and measuring the echo time delay and intensity of reflected light. The procedure is fast, typically taking only a few minutes.
Optical coherence tomography allows ophthalmologists to see the retina layers and measure their thickness. It can reveal retinal abnormalities - fluid accumulation or damage caused by ocular syphilis.
Fluorescein angiography is an invasive technique that examines the circulation of the retina and choroid. It involves injecting a fluorescent dye (fluorescein) into a vein, and then taking rapid sequence photographs as the dye passes through the retinal blood vessels.
The images can identify blockages, leaks, or abnormal blood vessel growth. Fluorescein angiography helps detect retinal vasculitis, neovascularization, and vascular abnormalities associated with syphilitic eye disease.
List of Eye Conditions Caused by Syphilis
Below are the eye conditions that syphilis could potentially trigger:
Iritis
Anterior Uveitis
Intermediate Uveitis
Panuveitis
Choroiditis
Necrotizing Retinitis
Optic Neuritis
Interstitial Keratitis
Peripheral Keratitis
Scleritis
Episcleritis
Dacryoadenitis
Retinal Vasculitis
Conjunctivitis
If you wish to know more about the signs and symptoms of these eye problems from syphilis, what causes them, what types they are, and how they affect the eyes in detail, follow the "learn more" link down below.
LEARN MORE: Common Eye Conditions from Syphilis
Treatment of Ocular Syphilis
Early treatment of syphilitic eye disease may prevent irreversible damage and restore vision.
Antibiotic Therapy
The primary treatment for syphilis is antibiotics.
Penicillin
Alternative Antibiotics
The most effective antibiotic for treating syphilis is penicillin. Patients with syphilis eye infection tend to be treated with intravenous penicillin G. Only a medical specialist should recommend dosage and regimen!
For patients allergic to penicillin, alternative antibiotics (doxycycline or ceftriaxone) may be used.
Corticosteroids
In addition to antibiotics, some doctors prescribe corticosteroids to reduce inflammation and prevent further syphilis damage to eye tissues. These can be administered orally, topically (eye drops), or as injections depending on the severity of the condition.
Follow-Up Care
Regular follow-up visits help monitor the response to treatment. Follow-up includes repeat blood tests, eye exams, and sometimes - imaging studies to assess vision restoration.
Conclusion
Syphilis can seriously affect the eyes, so it's key to catch it early and get the right treatment. Knowing the syphilis eye symptoms and seeing a doctor as soon as they appear can limit complications and save your vision.
Resources:
Ocular Syphilis, Cleveland Clinic
Ocular syphilis: Symptoms and treatment when syphilis spreads to the eyes, All About Vision
✅ Medically reviewed
Checked by Atanas Bogoev, MD.