This report details the current approach for the management of syphilitic uveitis.

Study design

Researchers administered a 25-question survey to 103 uveitis specialists who were members of the International Ocular Inflammation Society (IOIS).

Outcomes

There is agreement among uveitis specialists that the number of syphilitic uveitis cases are increasing. Most common presentations include posterior or panuveitis during secondary, tertiary or latent syphilis stages. More than 60% report seeing visually significant complications such as optic neuropathy and cystoid macular edema. Patients were commonly co-managed with infectious disease physicians, and treated with penicillin plus systemic or topical corticosteroids.

A majority of specialists reported using simultaneous testing with treponemal and non-treponemal diagnostic tests, with 20% utilizing reverse testing with treponemal specific assays first. More than 80% test any patient with uveitis for syphilis; 97% of participants order HIV testing for any patient diagnosed with syphilitic uveitis. Initial misdiagnosis, optic neuropathy, bilateral disease and HIV coinfection were associated with poor visual prognosis.

Limitations

The limitation of this study is that it surveyed specialists in eye inflammation from a single international society, and may not be representative of practice patterns among non-uveitis specialists.

Clinical significance

This study reviews common practice patterns of eye inflammation specialists in the diagnosis and management of syphilitic uveitis. Misdiagnosis remains an issue which can impact visual prognosis for patients; uveitis specialists can work to educate referring providers on the importance of keeping syphilitic uveitis in the differential for all patients presenting with ocular inflammation.