Syphilitic posterior uveitis: Correlative findings and significance

Twenty-one patients with syphilitic posterior uveitis were investigated ret rospectively to study the disease spectrum, associations with neurosyphilis , and therapeutic implications. Ophthalmologic manifestations of syphilitic posterior uveitis are differentiated into acute and chronic uveitides. The several distinct acute uveitic syndromes are usually florid and are associ ated with early syphilis, with VDRL-positive syphilitic meningitis, and fre quently with human immunodeficiency virus coinfection. The chronic posterio r uveitides are often insidious, a manifestation of late syphilis, and asso ciated commonly with subclinical neurosyphilis. All patients with acute cas es and 54% of patients with chronic cases in our study received penicillin therapy appropriate for neurosyphilis. The frequent association of syphilit ic posterior uveitis with neurosyphilis and the analogous spirochetal seque stration beyond the blood-brain and the blood-ocular barriers suggest that all patients with syphilitic posterior uveitis, irrespective of ocular dise ase intensity, should undergo evaluation of cerebrospinal fluid and be trea ted with penicillin regimens appropriate for neurosyphilis.