Department of Ophthalmology and Visual Sciences, University of Maryland Medical Center, Baltimore, Maryland.
Creighton University Medical School, Omaha, Nebraska.
J Emerg Med. 2022 Aug;63(2):296-299. doi: 10.1016/j.jemermed.2022.05.019. Epub 2022 Aug 27.
Syphilis is a sexually transmitted infection that has been increasing in prevalence since the early 2000s. Ocular involvement occurs in a minority of patients and must be in the differential diagnosis for patients who present with red eye and uveitis.
A 29-year-old woman presented to the emergency department with a painful, mydriatic red eye. Review of systems revealed a rash as well as a recent genital lesion and, on further questioning, she admitted to a history of intravenous drug use and high-risk sexual activity. Ophthalmology was consulted and the patient was diagnosed with bilateral uveitis. Serologic testing was positive for syphilis, and she was admitted and treated with intravenous penicillin, with resolution of her uveitis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Red eye is a common ocular symptom in patients presenting to the emergency department. The differential diagnosis of the red eye is broad and can range from benign etiologies, such as conjunctivitis, to life- and sight-threatening conditions, such as endogenous endophthalmitis. Systemic diseases such as syphilis may present with primarily ocular symptoms, and ocular syphilis must be identified and managed appropriately to prevent devastating sequelae.
梅毒是一种性传播感染，自 21 世纪初以来其发病率一直在上升。少数患者会出现眼部受累，对于出现眼红和葡萄膜炎的患者，必须将其纳入鉴别诊断。
一名 29 岁女性因疼痛性散瞳性红眼到急诊就诊。系统回顾显示皮疹以及近期的生殖器病变，进一步询问时，她承认有静脉吸毒和高危性行为史。眼科会诊后，患者被诊断为双侧葡萄膜炎。血清学检测梅毒呈阳性，她被收治入院并接受静脉注射青霉素治疗，葡萄膜炎得到缓解。
为何急诊医生应该了解这一点？：红眼是患者到急诊就诊的常见眼部症状。红眼的鉴别诊断范围很广，从良性病因（如结膜炎）到危及生命和视力的疾病（如内源性眼内炎）不等。梅毒等系统性疾病可能主要表现为眼部症状，必须识别和适当处理眼部梅毒，以防止发生严重的后遗症。
