Angle-closure glaucoma as a presumed presenting sign in patients with syphilis

Background: Angle-closure glaucoma is a well-known sequel to syphilitic int erstitial keratitis. This study describes angle-closure glaucoma in the abs ence of corneal opacity as a presumed presenting sign of syphilis. Cases: Two patients presented with angle-closure glaucoma with high periphe ral anterior synechiae to the level over Schwalbe's line extending the whol e circumference of the angle. Neither corneal opacity nor aqueous inflammat ion was present. Diffuse or localized retinochoroidal degeneration with pig mentation was found in 1 eye of 1 patient and in both eyes of the other pat ient. Observations: Fluorescein angiography revealed dotty retinal pigment epithe lial damage even in normal appearing areas of the fundus. The patients show ed a positive test for Treponema pallidum hemagglutination and also a low t iter of serological tests for syphilis. No systemic activity, such as skin rashes, had been noted. Conclusions: Syphilis should be considered in patients presenting high peri pheral anterior synechiae involving the whole circumference of the angle ev en in the absence of preceding interstitial keratitis. Jpn J Ophthalmol 200 0;44:305-308 (C) 2000 Japanese Ophthalmological Society.