In no phase of the pathology or treatment of syphilis is there so much disagreement as in primary optic atrophy. There is confusion as to the types of neurosyphilis in which primary optic atrophy usually occurs, one group believing it always to be associated with tabes dorsalis, another insisting on its frequent association with "basilar meningitis" and assigning a different prognosis from that of tabetic optic atrophy to the latter classification. There is no definite knowledge as to the underlying pathologic changes, one group ascribing the lesion to the direct action of the spirochete on the optic nerve, another to a hypothetic toxin, another to nutritional disturbances of the nerve due to vascular lesions involving its blood supply, and still another to disturbances in the interrelationships of systemic and retinal blood pressure and intra-ocular tension.
In treatment, one large school of thought holds that, while antisyphilitic drugs do no harm,
MOORE JE, WOODS AC, HOPKINS HH, SLOAN LL. THE TREATMENT OF SYPHILITIC PRIMARY OPTIC ATROPHY. JAMA. 1938;111(5):385-387. doi:10.1001/jama.1938.02790310007003