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Syphilitic neuroretinitis, a report of three cases and review of literature

Acquired syphilis has a propensity to affect any of the ocular tissues including the optic nerve. With the present AIDS epidemic, the prevalence of concurrent syphilis is on the increase. It is important to recognize syphilitic involvement of the optic nerve in its earlier stages, because specific and effective antimicrobial therapy is available. As syphilitic neuroretinitis does not have any characteristic clinical pattern and VDRL has only a low sensitivity in ocular syphilis, the condition is often treated initially with systemic corticosteroids. Such a situation could be avoided by eliciting a detailed and careful history, performing meticulous evaluation for systemic signs such as skin involvement, and repeating the VDRL test for syphilis. In this report, we describe three cases of neuroretinitis in which the diagnosis of syphilis was initially missed and all cases were treated with systemic corticosteroids. We discuss reasons for such a delayed diagnosis and also present a review of the literature.