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.
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.
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.
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