Abstract
Ocular syphilis is a significant manifestation of neurosyphilis that can occur at any stage of syphilis infection and may affect one or both eyes. The most common symptoms include reduced vision, pain, photophobia, and flashes of light. Uveitis and otic neuropathies are frequently observed ocular manifestations. If left untreated, ocular syphilis can result in permanent vision loss, highlighting the importance of thorough evaluation and timely treatment. We present the case of a 44-year-old woman, who exhibited symptoms including a maculopapular rash on the trunk and upper limbs, followed by cervical lymphadenopathy, tonsillitis, and decreased vision. Serological tests showed positivity for Venereal Disease Research Laboratory (1:32) and Treponema pallidum haemagglutination (1:10,240). An magnetic resonance imaging of the brain ruled out any pathological intracranial impregnations. Analysis of the cerebrospinal fluid revealed normal cellularity. An ocular ultrasound and a Doppler examination of the ophthalmic artery were conducted to assess the Ocular Assessment Rating Index (OARI). A retinal detachment was observed in the right eye, showing a significant increase in OARI compared to the left eye (0.82 vs. 0.68). A clinically significant increase in OARI was defined as a value >0.75 based on previous observations. The patient was treated with aqueous crystalline penicillin G for 10 days. This case highlights a potential link between damage to the ophthalmic and cerebral vascular systems and systemic manifestations in early syphilis. We propose that Doppler of the ophthalmic artery, with resistance index calculation, should be part of the diagnostic evaluation for patients with syphilis. An increased OARI may identify patients who should undergo lumbar puncture to confirm a diagnosis of neurosyphilis and initiate appropriate therapy.