Send to

Choose Destination
Br J Ophthalmol. 2019 Jan 30. pii: bjophthalmol-2018-313207. doi: 10.1136/bjophthalmol-2018-313207. [Epub ahead of print]

Current ophthalmology practice patterns for syphilitic uveitis.

Author information

Flinders University, Adelaide, South Australia, Australia.
University of São Paulo, Ribeirão Preto, Brazil.
Sadalla Amin Ghanem Eye Hospital, Joinville, Brazil.
Sydney University, Sydney, Australia.
Flinders University, Adelaide, South Australia, Australia
Contributed equally



Syphilitic uveitis is re-emerging alongside the systemic infection. In July 2017, an international group of uveitis-specialised ophthalmologists formed the International Ocular Syphilis Study Group to define current practice patterns.


103 Study Group members based in 35 countries completed a 25-item questionnaire focused on case load, clinical presentations, use and interpretation of investigations, treatment and clinical indicators of poor prognosis.


Members managed a mean of 6.1 patients with syphilitic uveitis in clinics that averaged 707 annual cases of uveitis (0.9%); 53.2% reported increasing numbers over the past decade. Patients presented to more members (40.2%) during secondary syphilis. Uveitis was usually posterior (60.8%) or pan (22.5%); complications included optic neuropathy, macular oedema and posterior synechiae. All members diagnosed syphilitic uveitis using serological tests (simultaneous or sequential testing algorithms), and 97.0% routinely checked for HIV co-infection. Cerebrospinal fluid (CSF) analysis was ordered by 90.2% of members, and 92.7% took uveitis plus Venereal Disease Research Laboratory test (VDRL) or fluorescent treponemal antibody absorption test (FTA-ABS) to indicate neurosyphilis. Patients were commonly co-managed with infectious disease physicians, and treated with penicillin for at least 10-14 days, plus corticosteroid. Features predicting poor outcome included optic neuropathy (86.3%) and initial misdiagnosis (63.7%). Reasons for delayed diagnosis were often practitioner-related. 82.5% of members tested every patient they managed with uveitis for syphilis.


This comprehensive report by an international group of uveitis-specialised ophthalmologists provides a current approach for the management of syphilitic uveitis.


eye, syphilis, uveitis; infection; inflammation

Supplemental Content

Full text links

Icon for HighWire
Loading ...
Support Center