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Multimodal imaging patterns of posterior syphilitic uveitis: a review of the literature, laboratory evaluation and treatment

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Abstract

Purpose

To review the multimodal imaging patterns of posterior syphilitic uveitis.

Methods

A systematic review.

Results

The percentage of syphilis has started to increase again: The World Health Organization has reported 12 million new cases of syphilis each year. In addition, syphilis was responsible for 0.3% of deaths globally in 2002. Eye manifestations happen prevalently in secondary and tertiary stages of syphilis, even though ocular involvement can occur in all stages. Syphilis has the nickname: “the great imitator” since it has no unique clinical presentation, even though posterior uveitis is considered the most common form. Syphilis is known as “the great imitator,” making its diagnosis in the presence of posterior uveitis particularly challenging as it presents similarly to other ocular conditions such as acute retinal necrosis. However, with the advent of multimodal imaging some particular patterns of pre-retinal, retinal, retinochoroidal and optic nerve involvement from syphilis can be identified to guide the diagnosis and the laboratory workup.

Conclusion

This review highlights the various patterns of pre-retinal precipitates, multifocal retinitis, retinochoroiditis (confluent and placoid) and optic neuritis caused by syphilis, the appropriate laboratory work to be obtained and the treatment to be initiated.

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Authors and Affiliations

  1. Eye Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, PO Box 112412, Abu Dhabi, UAE

    Francesco Pichi & Piergiorgio Neri

  2. Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, USA

    Francesco Pichi & Piergiorgio Neri

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  1. Francesco Pichi
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Correspondence to Francesco Pichi.

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F Pichi and P Neri declare that they have no conflict of interest.

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Pichi, F., Neri, P. Multimodal imaging patterns of posterior syphilitic uveitis: a review of the literature, laboratory evaluation and treatment. Int Ophthalmol 40, 1319–1329 (2020). https://doi.org/10.1007/s10792-020-01285-9

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