One of the ocular manifestations of syphilis is syphilitic papillitis, which is involvement of the anterior optic nerve including the optic disc.
Clinical features:
(1) ocular pain
(2) dyschromatopsia
(3) reduced visual acuity
(4) enlarged blind spot with central scotoma
On fundoscopy the optic disc is swollen and there may be a diffuse, patchy retinitis.
Orbital MRI shows gadolinium enhancement of the optic nerve.
The diagnosis of syphilis is usually based on serum serologic testing. Involvement of the optic nerve requires testing of the CSF to exclude other diagnoses and to look for evidence of neurosyphilis.
Causes of anterior optic neuritis include:
(1) multiple sclerosis
(2) viral infection
(3) bacterial infection
(4) diabetes mellitus
(5) hyperthyroidism
Differential diagnosis of anterior optic neuritis:
(1) papilledema
(2) syphilitic perineuritis
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