Faculty of Medicine, University of Toronto (AK); Department of Ophthalmology and Vision Sciences, Faculty of Medicine (LD, TJ-P, EM); Division of Neurology, Department of Medicine, Faculty of Medicine (EM), University of Toronto, Toronto, Canada.
J Neuroophthalmol. 2022 Mar 1;42(1):e173-e180. doi: 10.1097/WNO.0000000000001302. Epub 2021 Dec 23.
Syphilis is an uncommon cause of optic nerve head edema; however, differentiating syphilis from other etiologies of optic nerve head swelling may be challenging. We describe 4 cases of ocular syphilis presenting with swollen optic nerve head(s) without overt signs of intraocular inflammation to better define the phenotypic presentation of this condition to allow its early recognition and treatment and discuss potential pathophysiological mechanisms of syphilitic optic neuropathy.
Retrospective case series of patients presenting to a tertiary neuro-ophthalmology practice with a swollen optic nerve head(s) but no overt signs of intraocular inflammation, which was eventually determined to be secondary to syphilis.
Four patients were included in the study. The mean age was 43 years, 2 were women and 2 had bilateral involvement. Two patients had a recent history of skin rash, and one patient was investigated for abdominal pain and elevated liver enzymes. Two patients presented with photopsias and preserved visual function, whereas 2 presented with vision loss. Although chorioretinitis was present in all cases, it was very subtle in all and was only appreciated on fundus autofluorescence (FA) in 3 of 4 cases. Three patients demonstrated evidence of optic perineuritis on neuro-imaging. All patients were treated with a course of intravenous penicillin with a variable degree of visual recovery.
Systemic symptoms are common in patients with syphilic optic neuropathy. Optic disc edema as a manifestation of syphilis is usually accompanied by subtle chorioretinitis, which is best appreciated on FA. Optic perineuritis is common in patients with syphilitic optic neuropathy, with its pathophysiology likely similar to meningitis seen in neurosyphilis.
梅毒是视神经头水肿的不常见原因；然而，将梅毒与视神经头肿胀的其他病因区分开来可能具有挑战性。我们描述了 4 例表现为视神经头肿胀而无明显眼内炎症迹象的眼部梅毒病例，以更好地定义这种情况的表型表现，从而能够早期识别和治疗，并讨论梅毒性视神经病变的潜在病理生理学机制。
回顾性病例系列研究，纳入在三级神经眼科就诊的视神经头肿胀但无明显眼内炎症迹象的患者，最终确定其原因为梅毒。
本研究纳入了 4 例患者。平均年龄为 43 岁，2 例为女性，2 例为双侧受累。2 例患者有近期皮疹史，1 例患者因腹痛和肝酶升高而接受检查。2 例患者出现光幻视和保留的视力功能，而 2 例患者出现视力丧失。尽管所有病例均存在脉络膜视网膜炎，但均非常轻微，仅在 4 例中的 3 例中通过眼底自发荧光（FA）才能观察到。3 例患者在神经影像学检查中显示视神经鞘炎的证据。所有患者均接受了一个疗程的静脉注射青霉素治疗，视力恢复程度不一。
梅毒性视神经病变患者常有全身症状。作为梅毒表现的视盘水肿通常伴有轻微的脉络膜视网膜炎，在 FA 上观察最佳。视神经鞘炎在梅毒性视神经病变患者中很常见，其病理生理学可能与神经梅毒中的脑膜炎相似。
