Eye lesions in syphilis

During syphilis, the cardiovascular, central nervous systems and other organs, including the eye, are affected at different stages of its course. Changes in the skin of the eyelids and conjunctiva appear. The cornea, vascular tract of the eye and retina are most often affected.

The consequences of congenital chorioretinitis have a characteristic ophthalmoscopic picture: on the periphery of the fundus there are many small grayish-white foci alternating with small pigment lumps. They give the fundus a specific appearance: as if it were sprinkled with salt and pepper. The retinal vessels are narrow, the optic disc is pale. Atypical forms are also observed, when only pigmented foci are visible in the peripheral part of the fundus, or, conversely, large white foci bordered by pigment in the form of a ring. Occasionally, the foci reach the central section. In the white foci, in addition to the pigment, the remains of deserted choroidal vessels are visible.

In acquired syphilis, the choroid and retina are affected in the second and third periods of the disease.

A distinction is made between diffuse and focal forms of syphilitic chorioretinitis. Diffuse chorioretinitis is typical for acquired syphilis. One of the first signs of the diffuse form of syphilitic chorioretinitis is a gentle opacity of the posterior vitreous. The optic disc is pink, its borders are not quite clear, the retina is edematous. Sometimes, against the background of the edematous retina, small pinkish or light gray foci without sharp borders are visible, about half the size of the optic disc. The foci are located in the area of the macula lutea or near it. The retinal vessels above the foci pass unchanged. Then changes occur in the pigment epithelium, pigment lumps are formed in the inner and middle layers of the retina. As a result of the pigment movement, diffuse discoloration of the choroid is detected and atrophied vessels of the choroid are visible against this background.

The optic disc becomes pale, takes on a gray tint, its borders are unclear. The retinal vessels are narrow. Typical optic nerve atrophy develops. Vision is sharply reduced. Choroiditis is often combined with iridocyclitis.

Disseminated chorioretinitis in syphilis is difficult to distinguish from disseminated chorioretinitis of other etiologies. Serological reactions are of great importance.

Specific treatment is performed by a venereologist. Locally, pupil dilators, corticosteroids in drops and subconjunctivally are used. In addition, drugs are used that improve retinal metabolism.

Syphilitic inflammation in the brain is accompanied by unilateral mydriasis and paralysis of accommodation, a picture of congestion of the optic disc occurs, and then neuritis and paralysis of the oculomotor nerve develop. A characteristic symptom is homonymous hemianopsia.

In tabes dorsalis, one of the early symptoms is the absence of pupillary response to light with preserved convergence response (Argyll Robertson's symptom). Later, optic atrophy develops, leading to complete loss of vision.

For treatment, corticosteroids are administered orally according to the scheme, as well as locally in the form of instillations of 0.1% dexamethasone solution, application of 0.5% hydrocortisone ointment and subconjunctival injections of 0.4% dexamethasone solution at 0.3 ml every other day. Desensitizing agents, angioprotectors and vitamins are prescribed. It is recommended to take indomethacin at 0.025 g 2-3 times a day. Locally - instillations of 3% potassium iodide solution or electrophoresis of 0.1% lidase solution. It is also recommended to administer broad-spectrum antibiotics (gentamicin, etc.) parabulbarly. Ultrasound is used to resolve hemorrhages, and laser coagulation of the affected retinal veins is performed according to indications.

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