Interstitial keratitis
 

Avoid using the term syphilis in the presence of the patient. Use euphemism such as ' the condition may be caused by  TPHA or St. Luis disease'. The cornea has diffused stromal haze and on high manifestation there are ghost (empty) vessels in the deep and mid-stroma. The cornea may be thin. The condition is usually bilateral. Look for the following: signs of congenital syphilis such as saddle-nose, deafness and under-developed dentition. there may be cornea graft in the opposite eye. .

Questions:

1. How does luetic (syphilitic) keratitis present?

Answer
It occurs in congenital syphilis and usually develops in the first or second decades of life. It can be divided into three stages:
Early stage: characterized by ocular pain, photophobia. There is deep stroma and endothelial oedema. Keratic precipitates may occur.
Florid stage: when the inflammation is at its peak with iridocyclitis. There is deep stroma vessels which gives a pink colour to the cornea (salmon pink)
Regression: vascular regression with clearing of the stromal infiltrates leaving behind corneal scarring. This may take up to 1 or 2 years to resolve unless topical steroid is used.

2. What signs constitute the Hutchinson's triad?

Answer
Saddle-nose, interstitial keratitis and Hutchinson's teeth (widely spaced peg-shaped upper incisors with a crescentic notch at the cutting the edge).

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