Inflammatory ocular hypertension syndrome (IOHS) in Patients with Syphilitic Uveitis

Abstract

Aim: To determine the prevalence and clinical characteristics of the Inflammatory ocular hypertension syndrome (IOHS) in patients with uveitis and serologic evidence of syphilis.

Methods: We performed a retrospective, observational case review of 39 consecutive patients with uveitis and serologic evidence of syphilis between January, 1977, and December, 2001, at The Francis I. Proctor Foundation of the University of California, San Francisco. History, examination, and directed laboratory testing were used to exclude other causes of uveitis. The prevalence and clinical characteristics of IOHS among patients with uveitis and serologic evidence of syphilis were documented. Inflammatory ocular hypertension syndrome was defined as intraocular pressure (IOP) elevation greater than 21mmHg that began at the onset of acute, recurrent, or chronic anterior chamber inflammation, and which reversed promptly with appropriate anti-inflammatory and/or antimicrobial therapy.

Results: Of the 39 patients with uveitis and serologic evidence of syphilis, 8 eyes of 7 patients (18%) presented with IOHS. This was significantly higher than the prevalence of IOHS in the uveitis population at large (2.3%; P<0.001). Best-corrected visual acuity varied from 20/20 to 20/200, with a median of 20/40 and 3 of the 8 eyes (37.5%) had granulomatous features, including large keratic precipitates and, in 2 eyes, Koeppe nodules. Intraocular pressure varied from 23mmHg to 51mmHg, with a mean of 36mmHg and a median of 34mmHg, respectively. One patient had IOHS bilaterally.

Conclusion: Syphilitic uveitis should be included in the differential diagnosis of IOHS along with more commonly recognized causes, such as herpetic anterior uveitis, sarcoid uveitis, toxoplasmic retinochoroiditis, and the Posner-Schlossman syndrome.