Ocular Microbiology and Immunology Group
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2019 OMIG Abstract

A Review of Ocular Manifestations of Syphilis at Parkland Hospital

Nikitha Reddy MD, Mohamed Guenena MD, Alexandria Chaulk BA, Niraj Nathan MD, Chan Nguyen MD
Department of Ophthalmology: The University of Texas Southwestern Medical Center

Methods: This is a retrospective chart review of all patients diagnosed with syphilis at Parkland Hospital from 6/1/2005 to 10/1/2017 to review ocular manifestations and visual prognosis. Each patient’s clinical course, medical history, labs, and ophthalmic notes were reviewed.

Results: Of 109 charts reviewed, 22 patients (32 eyes) with ocular involvement were identified. The most common manifestation of ocular syphilis upon presentation was uveitis (20/32 eyes, 63%). Of those, 6 eyes (30%) had anterior uveitis, 2 (10%) posterior uveitis/chorioretinitis, 11 (55%) panuveitis, and 1 (5%) unspecified based on the documentation. Final visual acuity ranged from 20/25 to 20/200 in eyes with anterior uveitis and from 20/25 to count fingers at 1 foot in panuveitis eyes. Two eyes (6%) had interstitial keratitis, 2 eyes (6%) showed third nerve palsy, 4 eyes (13%) had glaucoma, and 4 eyes (13%) had optic neuropathy/atrophy. Positive RPR test was present in 18 patients (82%). All patients had a positive fluorescent treponemal antibody absorption (FTA-Abs) test. 13 patients (59%) had a lumbar puncture, 7 of which had a positive CSF VDRL. Nineteen (86%) patients were treated with either intravenous (IV) or intramuscular (IM) penicillin; 3 patients did not have treatment information available. Concurrent HIV was present in 14 patients (64%), and there was negative correlation between RPR (rapid plasma reagin) levels and CD4 count (r=-0.074) and viral loads (r=-0.211) at the time of syphilis diagnosis.

Conclusion: Uveitis was the most common ocular finding in this cohort of syphilis patients. Following treatment, RPR titers in all patients decreased. In our study, some patients did not get an LP, yet still got treated for neurosyphilis based on clinical suspicion. The HIV co-infection rate was high (64%). It is recommended that all patients presenting with ocular syphilis be tested for HIV. Syphilis is an important cause of ocular morbidity and should be treated aggressively to avoid long-term systemic and ocular consequences.

Disclosure: N

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