Syphilitic Optic Neuropathy

  • An-Guor Wang


A 40-year-old male complained of blurred vision in the right eye for 6 days. The patient had congenital heart disease and underwent a cardiac operation at age 14. His past medical history also included nephritis with subsequent nephrectomy at age 19. In his 20s, he was treated for a sexually transmitted disease. His best-corrected visual acuity was 6/15 in the right eye and 6/5 in the left. He could identify only 6 plates in the right eye and 14 plates in the left with the Ishihara color test. The anterior segment was normal for both eyes. Ophthalmoscopic examination revealed bilateral disc swelling with hyperemic change (Fig. 4.1). Central scotoma was noted in both eyes (Fig. 4.2). There was no enhancing lesion found along the optic nerve (Fig. 4.3). Blood tests showed normal white blood cell counts with a mildly depressed lymphocyte percentage (16%) and an increased eosinophil percentage (6.6%). CSF study was unremarkable. Inflammatory indices such as ESR and CRP were both elevated. Syphilitic tests were all positive, with serum VDRL 1:16 (+), TPHA 1:2560 (+), and FTA-ABS (4+) reactive. The patient received intravenous aqueous PCN treatment, and his vision improved to 6/8.6 in the right eye.


  1. 1.
    Northey LC, Skalicky SE, Gurbaxani A, McCluskey PJ. Syphilitic uveitis and optic neuritis in Sydney, Australia. Br J Ophthalmol. 2015;99(9):1215–9.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Sahin O, Ziaei A. Clinical and laboratory characteristics of ocular syphilis, co-infection, and therapy response. Clin Ophthalmol. 2015;10:13–28.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Aldave AJ, King JA, Cunningham Jr ET. Ocular syphilis. Curr Opin Ophthalmol. 2001;12:433–41.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Anshu A, Cheng CL, Chee SP. Syphilitic uveitis: an Asian perspective. Br J Ophthalmol. 2008;92:594–7.CrossRefPubMedGoogle Scholar
  5. 5.
    O'Connell K, Marnane M, McGuigan C. Bilateral ocular perineuritis as the presenting feature of acute syphilis infection. J Neurol. 2012;259(1):191–2.CrossRefPubMedGoogle Scholar
  6. 6.
    Kim EB, Jin K, Choi DG, Bae SH. Neurosyphilis initially presenting as hemorrhagic exudative optic neuropathy in an immunocompetent patient. Sex Transm Dis. 2015;42(6):345–6.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Prokosch V, Thanos S. Emerging syphilitic optic neuropathy: critical review and recommendations. Restor Neurol Neurosci. 2008;26:279–89.PubMedGoogle Scholar
  8. 8.
    Browning DJ. Posterior segment manifestations of active ocular syphilis, their response to a neurosyphilis regimen of penicillin therapy, and the influence of human immunodeficiency virus status on response. Ophthalmology. 2000;107:2015–23.CrossRefPubMedGoogle Scholar
  9. 9.
    Walsh FB, Hoyt WF. Infections and parasitic invasions of the nervous system. In: Clinical neuro-ophthalmology, vol. 2. 3rd ed. Baltimore: Williams and Wilkins; 1969. p. 1581–91.Google Scholar
  10. 10.
    De Silva SR, Chohan G, Jones D, Hu M. Cytomegalovirus papillitis in an immunocompetent patient. J Neuroophthalmol. 2008;28(2):126–7.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Mansour AM. Cytomegalovirus optic neuritis. Curr Opin Ophthalmol. 1997;8(3):55–8.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Smith GT, Goldmeier D, Migdal C. Neurosyphilis with optic neuritis: an update. Postgrad Med J. 2006;82(963):36–9.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • An-Guor Wang
    • 1
  1. 1.Department of OphthalmologyTaipei Veterans General Hospital, National Yang-Ming University School of Medicine, Yun-San Ophthalmology Education Research FoundationTaipeiTaiwan

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