Syphilitic Uveitis Flashcards
(Syphilitic uveitis) When talking about the manifestations of syphilis, this distiction must be considered first:
- Acquired
- Congenital
(Congenital Syphilis) What is the most common ocular manifestation of congenital syphilis?
Intersticial keratitis
(Congenital Syphilis) In general terms, what is intersticial keratitis (IK)?
An inflammatory condition of the corneal stroma in the absence of primary involvement of either the corneal epithelium or endothelium
(Congenital Syphilis - IK) What does it mean to say the corneal stroma in inflamed?
It means inflammatory cells are present in the interlamellar stroma
(Congenital Syphilis - IK) So, there’s pus in the stroma?
NO - IK is a nonsupurative condition. IK represents a Tipe IV hypersensitivity reaction to antigens within the cornean stroma.
(Congenital Syphilis - IK) At what age does the IK of congenital syphilis typically present?
Around 9 years
(Congenital Syphilis - IK) How does it present?
Pain, photophobia and injection, +/- a salmon patch
(Congenital Syphilis - IK) With the respect to IK, to what does the term salmon patch refer?
As the disease progresses, deep stromal vessels appear and make their way toward the central cornea. if/when the stromal vascularization is aprticularly dense and the blood flow is exuberant, the resulting color of the cornea has been likened to that of salmon.
(Congenital Syphilis - IK) How is it treated?
WIth frequent topical steroids
(Congenital Syphilis - IK) What is the natural course of syphilitic IK if it goes untreated?
It tends to burn itself out in a matter of weeks to months.
(Congenital Syphilis - IK) Irrespective of whether it was treated, what stigmata of resolved IK that may be seen at the slit lamp?
- Formerly perfused, now-empty stromal blood vessels (aka ghost vessels)
- Corneal scarring, which may produce visually significant haze and/or astigmatism
(Congenital Syphilis - IK) What is the most common cause of IK (Hint: It’s not syphilis)?
Herpetic dz
(Congenital Syphilis - IK) Other than herpesviruses and T. pallidum, three other infections causes of IK are worth mentioning (in thar they would make good OKAP questions). What are they?
- Mycobacterium tuberculosis (ie, TB)
- Mycobacterium leprae (leprosy/Hansen’s dz)
- Borrelia burgdorferi (Lyme dz)
(Congenital Syphilis - IK) There is a noninfectious cause worth mentionning (for the same reason) – what is it?
Cogan Syndrome
(Congenital Syphilis - IK) There is a noninfectious cause worth mentionning (for the same reason) – what is it? Cogan Syndrome.
How does Cogan Syndrome present?
With IK and CN8-related symptoms: deafness, tinnitus and vertigo.
(Congenital Syphilis) What is the most common manifestation of congenital Syphilis in the posterior pole?
TWO manifestations are common:
- a salt-and-pepper retinopathy
- a retinitis pigmentosa (RP)-like presentation: OHN pallor, arteriolar narrowing, RPE clumping
(Congenital Syphilis) What is the other classic cause of congenital salt-and-pepper retinopathy?
Rubella
(Congenital Syphilis) What are the classic nonocular findings associated with congenital syphilis?
- Circumoral scars (formal term: Rhagades)
- Hutchinson teeth (“Peg-shaped”)
- Saddle nose
- Saber shins
- Mental retardation
- CN8 deafness
(Congenital Syphilis)
Hutchinson teeth: Name two other congenital eye syndromes that are associated with abnormal dentition:
- Axenfeld-Rieger
- Incontinentia pigmenti
In three words, what sort of condition is Axenfeld-Rieger?
An anterior-segment dysgenesis.
If limited to one word, what sort of condition is Axenfeld-Rieger?
A neurocristopathy.
In one word, what sort of condition is incontinentia pigmenti?
A phakomatosis.
(Congenital Syphilis)
Saber shins: Why sabr shins; ie, to what does this term refer?
It refers to the fact that the tibia of congenital-syphilis pts tendt to be shaped like a saber, a type of sword.
(Congenital Syphilis) In the context of congenital syphilis, what three findings constitute Hutchinson’s triad?
- Interstitial keratitis
- Deafness
- Hutchinson teeth
(Congenital Syphilis) Recall that Cogan’s syndrome is amrked by IK and CN8 dysfunction. If a patient with both of these, how you can determine whether they have Cogan’s syndrome vs congental syphilis?
1) The IK of congenital syphilis presents at 9, whereas Cogan’s presents in young adulthood.
2) The congenital syphilis pt with have the other stigmata of their condition, which are not present in Cogan’s syndrome.
(Acquired Syphilis: Overview) Syphilis infection passes through four stages – what are they?
- Primary syphilis
- Secondary syphilis
- Latency period
- Tertiary syphilis
(Acquired Syphilis: Overview) How much time typically passes between inoculation and the onset of primary syphilis?
~3 weeks post inoculation.
