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Syphilitic interstitial keratitis and glaucoma
Last reviewed: 11.04.2020
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Syphilis of the eye can be a congenital or acquired disease, transmitted sexually.
In congenital syphilis, as a rule, the anterior segment of the eye is affected with the development of interstitial keratitis and anterior uveitis, and with acquired syphilis, both anterior and posterior uveitis develop. With the development of effective diagnostic methods and antibiotic therapy, syphilitic interstitial keratitis and secondary glaucoma have become rare diseases.
Epidemiology of syphilitic interstitial keratitis
Lesion of the eye with congenital or acquired syphilis can lead to increased intraocular pressure and the development of secondary glaucoma both during the active inflammatory stage and many years after the resolution of the intraocular inflammatory process. In 15-20% of adults with a history of interstitial keratitis associated with congenital syphilis, secondary glaucoma developed. Secondary glaucoma in patients with acquired syphilis is less common.
[What causes syphilitic interstitial keratitis?
Probably, the cause of increased intraocular pressure in the active stage of the disease is a violation of the outflow of intraocular fluid due to inflammation cells and proteins present in the intraocular fluid. The formation of synechia, violation of the development of the eyeball and subluxation of the lens may lead to a narrowing of the anterior chamber angle and the development of closed-angle glaucoma. It is believed that the basis for the late manifestation of glaucoma in patients with congenital syphilis is the "endothelialization" of the anterior chamber angle, which is revealed by histological examination.
Symptoms of syphilitic interstitial keratitis
The defeat of the eye with congenital syphilis usually manifests itself sharply in the age of up to 20 years and includes the following symptoms: pain, photophobia, lacrimation, decreased visual acuity. In 90% of cases, bilateral damage is observed. There may be other symptoms of congenital syphilis: deformities of the teeth (Getschinson's teeth and kisetoobraznye molars), skeletal anomalies (saddle nose, bone skull perforation, saber-like shin and protruding frontal tubercles), deafness, fissures on the skin and dementia. For acquired syphilis of the eye, one-sided lesion is more common.
Course of the disease
The duration of the course of interstitial keratitis and anterior uveitis ranges from several weeks to several months, after which a spontaneous resolution of the process takes place, with the desiccated vessels remaining in the deep layers of the corneal stroma. Glaucoma is referred to late complications of congenital syphilis. It, as a rule, develops already in the absence of signs of intraocular inflammation, decades after the resolution of interstitial keratitis. Open angle and narrow-angle glaucoma develop in these patients with the same frequency.
Diagnosis of syphilitic interstitial keratitis
When conducting an ophthalmological examination of patients suffering from congenital syphilis, a number of diseases can be detected: acute and chronic anterior uveitis, cataract, chorioretinitis, retinal vasculitis, optic neuritis and scleritis. The most common interstitial keratitis is found. When examining patients suffering from interstitial keratitis, the sectoral edema of the cornea is revealed, its turbidity and deep stromal vascularization, which can be so pronounced that in this place the color of the cornea becomes orange-pink. With syphilitic interstitial keratitis, anterior uveitis and an increase in intraocular pressure often develop. Ophthalmic examination of patients with acquired syphilis often reveals anterior uveitis, chorioretinitis and optic neuritis. Interstitial keratitis with syphilis is rarely seen, as a rule, one eye is affected. With the development of anterior uveitis in patients with acquired syphilis, nodular iris formations are often detected.
Differential diagnostics
The active stage of ocular syphilis, characterized by interstitial keratitis and anterior uveitis, should be differentiated from the processes caused by herpes simplex and herpes zoster, Mycobacterium tuberculosis and leprae, Lyme disease, measles, infectious mononucleosis (Epstein-Barr virus), leishmaniasis and onchocerciasis, sarcoidosis and Kogan's syndrome.
Laboratory research
The diagnosis of syphilis of the eyes is based on positive serological reactions. Studies of the veneral disease lab and rapid plasma reagin alone are not sufficient, therefore, research is needed to detect treponem: the adsorption of fluorescent antibodies to treponema, the microhemagglutination reaction for the presence of Treponema pallidum. Each patient suffering from syphilitic uveitis should undergo an examination of cerebrospinal fluid in order to avoid asymptomatic neurosyphilis.
Treatment of syphilitic interstitial keratitis
During the active stage of the disease, intraocular pressure is reduced by administering local glucocorticoids, cycloplegic and, if necessary, antiglaucoma drugs. It is also necessary to carry out antibiotic therapy of a systemic disease. With narrow- and closed-angle glaucoma, laser iridotomy or surgical iridectomy should be performed. In the late manifestation of open-angle glaucoma, antiglaucoma drugs are less effective, and an operation aimed at improving filtration may be required. Argon-laser trabeculoplasty is ineffective because of the "endothelialization" of the anterior chamber angle.