Inflammatory ocular hypertension syndrome (IOHS) in patients with syphilitic uveitis

Aim: To determine the prevalence and clinical characteristics of the inflammatory ocular hypertension syndrome (IOHS) in patients with uveitis and serological evidence of syphilis. Methods: A retrospective, observational case review of 39 consecutive patients with uveitis and serological evidence of syphilis was carried out between January 1977 and December 2001. Other causes of uveitis were excluded. The prevalence and clinical characteristics of IOHS among patients with uveitis and serological evidence of syphilis were documented. IOHS was defined as an increase in intraocular pressure (IOP) of more than 21 mm Hg that began at the onset of acute, recurrent, or chronic anterior chamber inflammation and reversed promptly with appropriate anti-inflammatory or antimicrobial treatment. Results: Of the 39 patients with uveitis and serological evidence of syphilis, eight eyes from seven patients (18%) presented with IOHS, a significantly higher prevalence than 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 three of the eight eyes (37.5%) had granulomatous features, including large keratic precipitates and, in two eyes, Koeppe nodules. Intraocular pressure varied from 23 to 51 mm Hg, with a mean of 36 and a median of 34. One patient had bilateral IOHS. Conclusions: Syphilitic uveitis should be included in the differential diagnosis of IOHS along with more commonly recognised causes.