Ye Zizhen, Yang Mingming, Zou Yaru, Zhang Jing, Deng Jiaxin, Zong Yuan, Ohno-Matsui Kyoko, Kamoi Koju
Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Tokyo 113-8510, Japan.
Department of Ophthalmology, Zhongshan Torch Development Zone People's Hospital, Zhongshan 528436, China.
Pathogens. 2025 Aug 27;14(9):852. doi: 10.3390/pathogens14090852.
Syphilis is a systemic infection with a broad spectrum of ocular involvement that can affect every segment of the eye. Clinical presentations range from interstitial keratitis, conjunctivitis, episcleritis, and scleritis to anterior, intermediate, and posterior uveitis; acute syphilitic posterior placoid chorioretinitis; retinitis; retinal vasculitis; neuroretinitis; optic neuritis; exudative retinal detachment; and optic nerve dysfunction. These manifestations may occur at any stage of infection and are frequently nonspecific, contributing to diagnostic delays. Diagnosis requires a high index of suspicion and is established by combined non-treponemal and treponemal serologic testing, with cerebrospinal fluid analysis when neurosyphilis is suspected. Multimodal imaging, including optical coherence tomography, fluorescein angiography, fundus autofluorescence, and visual field testing, enhances the detection of subclinical and atypical diseases. Management mandates prompt intravenous penicillin G, with adjunctive corticosteroids to mitigate Jarisch-Herxheimer reactions and control inflammation; ceftriaxone or doxycycline serve as alternatives for penicillin-allergic patients. Long-term follow-up with serial serologies and neurologic evaluation is essential to detect relapse or progression to neurosyphilis. Despite effective therapy, diagnostic delays contribute to irreversible visual loss in a significant proportion of cases. This review integrates current knowledge on ocular syphilis, emphasizing its varied presentations and the importance of early recognition to prevent vision-threatening complications, and calls for multidisciplinary, mechanism-based research to optimize outcomes. We conducted a literature search in Pubmed and Embase for articles published between 2000 and 2025, using the terms "ocular syphilis," "syphilitic uveitis," and "neurosyphilis," with a focus on epidemiology, clinical features, diagnostics, therapeutics, and co-infections.
梅毒是一种全身性感染，眼部受累范围广泛，可累及眼睛的各个部位。临床表现从间质性角膜炎、结膜炎、巩膜外层炎和巩膜炎到前、中、后葡萄膜炎；急性梅毒性后极部扁平状脉络膜视网膜炎；视网膜炎；视网膜血管炎；视神经视网膜炎；视神经炎；渗出性视网膜脱离；以及视神经功能障碍。这些表现可出现在感染的任何阶段，且通常不具有特异性，导致诊断延迟。诊断需要高度的怀疑指数，并通过非梅毒螺旋体和梅毒螺旋体血清学检测相结合来确定，当怀疑有神经梅毒时需进行脑脊液分析。多模态成像，包括光学相干断层扫描、荧光素血管造影、眼底自发荧光和视野检测，可提高对亚临床和非典型疾病的检测。治疗要求迅速静脉注射青霉素G，并辅以皮质类固醇以减轻吉海反应并控制炎症；头孢曲松或多西环素可作为青霉素过敏患者的替代药物。进行系列血清学检查和神经学评估的长期随访对于检测复发或进展为神经梅毒至关重要。尽管有有效的治疗方法，但诊断延迟在很大一部分病例中导致了不可逆转的视力丧失。本综述整合了关于眼部梅毒的现有知识，强调其多样的表现以及早期识别以预防威胁视力的并发症的重要性，并呼吁开展多学科、基于机制的研究以优化治疗结果。我们在Pubmed和Embase中检索了2000年至2025年间发表的文章，使用了“眼部梅毒”、“梅毒性葡萄膜炎”和“神经梅毒”等术语，重点关注流行病学、临床特征、诊断、治疗和合并感染。
