People with syphilis are prone to severe eye problems! Much so that an ophthalmologist can notice signs of syphilis and eye conditions from syphilis during an eye exam, even in the very early stages. Indeed, a potential diagnosis is possible just by examining the eye structures. Learn about the most common eye conditions caused by syphilis and their symptomatic nature in this article.
1. Uveitis
Uveitis is a common manifestation of ocular syphilis which inflames the uveal tract - iris, ciliary body, and choroid. Different types of uveitis may occur - iritis, intermediate uveitis, choroiditis, and panuveitis.
1.1. Anterior Uveitis (Iritis)
Anterior Uveitis is an inflammation of the iris. Symptoms include:
Eye pain
Eye redness
Blurred vision
Light sensitivity (photophobia)
Anterior uveitis is often accompanied by keratic precipitates (deposits on the corneal endothelium). It may cause increased intraocular pressure (IOP).
1.2. Intermediate Uveitis
Intermediate Uveitis is the one that affects the ciliary body and the vitreous humor. The most common symptoms are:
Eye redness
Floaters
Blurred vision
Intermediate uveitis can be complicated by the development of macular edema, which further impairs vision.
1.3. Posterior Uveitis (Choroiditis)
Choroiditis is a type of iritis which involves the choroid and retina. Symptoms may be:
Eye redness
Vision loss
Floaters
Scotomas (blind spots)
Posterior uveitis is often severe and eventually may lead to retinal detachment and optic nerve damage.
1.4. Panuveitis
Panuveitis involves inflammation of all parts of the uveal tract. This condition is quite severe, especially when triggered by a syphilis infection. It presents with a mix of symptoms from anterior, intermediate, and posterior uveitis.
RELATED: Eye Floaters: Are They Normal?
2. Necrotizing Retinitis
Retinitis is an inflammation of the light-sensitive tissue at the back of the eye (retina). Ocular syphilis can cause a specific type of retinitis known as necrotizing retinitis with these characteristics:
Vision loss
Presence of floaters
Photophobia
Retinal whitening (necrosis)
Hemorrhages visible on fundoscopy
Necrotizing retinitis can be severe and rapidly progressive. Results in significant visual impairment or blindness if not treated on time.
3. Optic Neuritis
Optic neuritis is optic nerve inflammation which can be a side effect of syphilis. The optic nerve is responsible for transmitting visual information from the eye to the brain. Symptoms of optic neuritis include:
Sudden vision loss in one or both eyes
Pain with eye movement
Reduced color vision (dyschromatopsia)
Visual field defects
Optic neuritis can result from direct invasion of the optic nerve by Treponema pallidum or secondary to inflammation extending from adjacent ocular structures. If a patient doesn't treat it, optic neuritis can permanently damage the optic nerve and cause irreversible vision loss.
4. Interstitial Keratitis
Interstitial keratitis is a chronic, non-suppurative inflammation of the cornea. Eye doctors often associate it with congenital syphilis but it can also occur in acquired syphilis. The warning signs include:
Eye pain
Redness
Tearing
Photophobia
Decreased vision due to corneal opacification
On examination, patients may have corneal stromal haze, deep vascularization, and the formation of ghost vessels (empty blood vessels in the cornea). Untreated interstitial keratitis can cause significant loss of vision.
5. Scleritis
Scleritis is the inflammation of the white outer layer of the eye (sclera). The condition is a painful and vision-threatening condition. Symptoms of scleritis are:
Severe, deep eye pain
Redness
Tearing
Sensitivity to light
Scleritis can be diffuse, nodular, or necrotizing, with necrotizing scleritis being the most severe form associated with syphilis. The possible complications are scleral thinning, perforation, and secondary glaucoma.
RELATED: What Causes Pain Behind the Eyes?
6. Episcleritis
Episcleritis is a relatively mild, self-limiting inflammation of the thin layer of tissue between the conjunctiva and sclera (episclera). It can be caused by syphilis and presents with:
Redness
Mild discomfort
No discharge
Episcleritis is typically not associated with severe pain or vision loss. It resolves with or without treatment. Yet, patients should undergo an eye exam to differentiate it from more serious conditions like scleritis.
7. Dacryoadenitis
Dacryoadenitis is the irritation of the lacrimal gland responsible for tear production. Syphilitic dacryoadenitis can cause:
Swelling and tenderness over the lacrimal gland (located in the upper outer part of the orbit)
Pain
Redness
Excessive tearing or discharge
While dacryoadenitis is less common in ocular syphilis, it should be considered in the differential diagnosis of patients presenting with lacrimal gland swelling and systemic signs of syphilis.
8. Retinal Vasculitis
Retinal vasculitis involves inflammation of the blood vessels in the retina. As a result, a person can suffer from:
Vision loss
Floaters
Photopsia (flashes of light)
Retinal vasculitis can cause ischemia and neovascularization, potentially resulting in retinal detachment and severe vision loss.
9. Conjunctivitis
Conjunctivitis, or pink eye, affects the conjunctiva - the transparent tissue covering the white part of the eye and the inside of the eyelids. While conjunctivitis is a less common manifestation of ocular syphilis, it may still occur. Symptoms include:
Redness
Eye discharge
Itching or irritation
Tearing
Pink eye associated with syphilis may present with follicles (small, raised bumps) on the conjunctiva and can be accompanied by other signs of an eye infection.
RELATED: Types of Eye Discharge
10. Other Eye Conditions
Syphilis can also affect the anterior segment, leading to eye conditions such as:
Posterior scleritis: Inflammation of the sclera at the back of the eye, causing severe pain and redness.
Peripheral keratitis: Inflammation at the periphery of the cornea, leading to pain and visual disturbances.
Iridocyclitis: Inflammation of the iris and ciliary body, causing eye pain, redness, and blurred vision.
These conditions are relatively rare for syphilis, but additional testing may be necessary to rule diagnosis out.
LEARN MORE: How Syphilis Affects the Eyes?
Resources:
Ocular Syphilis, Cleveland Clinic
✅ Medically reviewed
Checked by Atanas Bogoev, MD.