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Writer's pictureMaria Cholakova

How Syphilis Affects the Eyes? Symptoms and Treatment

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 bacteria illustration
Syphilis bacteria (Treponema Pallidum, TP) illustration, by Kateryna Kon, Science Photo Library

Syphilis develops in stages, each with distinct symptoms:


  1. Primary Syphilis: Painless sores (chancres) at the infection site.

  2. Secondary Syphilis: Skin rashes, mucous membrane lesions, fever, swollen lymph nodes, sore throat.

  3. Latent Syphilis: A symptom-free period where the bacteria remains in the body.

  4. 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


syphilis eye symptoms infographic

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.


Syphilis lab test
Syphilis Lab Test - the VDRL test checks if the patient's body is fighting syphilis by looking for specific antibodies

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.


Optical coherence tomography (OCT)
Optical coherence tomography (OCT) device

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.



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:


✅ Medically reviewed

Checked by Atanas Bogoev, MD.

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