Lesions involving the eyes or their external musculature are common in acquired and in congenital syphilis. They may present themselves as local lesions in the eyeball or orbit or may be local manifestations of intracranial infection.
Syphilitic involvements of the eye and adnexa most frequently seen1 are: Primary chancre of the lid and conjunctiva; interstitial keratitis, congenital and acquired; iritis, in acquired and in congenital infection; choroiditis, focal and disseminated; retinitis; changes in the optic disk, without intracranial involvement; atrophy of the optic nerve; paralysis of the ocular nerves by a gummatous process in the orbit, basal syphilitic meningitis, cerebral gumma or syphilitic neuritis of the nerve trunks, and nuclear degeneration from disease of the supplying vessels.
Gumma of the orbit is a rare condition.2 It occurs in two forms:
It may be a condition of the periosteum, especially in the upper and outer and the inner and lower quadrants of the orbit. Early it causes thickening of the structure and later necrosis, with possible breaking through the skin and formation of a sinus.
SNIDERMAN HR, GLICKLICH EA. LATE SYPHILIS WITH RARE ORBITAL GUMMA: REPORT OF A CASE. Arch Derm Syphilol. 1940;42(4):559–565. doi:10.1001/archderm.1940.01490160019003
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