<![CDATA[Ocular syphilis is an important and potentially sight-threatening manifestation of T. pallidum infection, capable of occurring at any stage of the disease. Known as “The Great Imitator,” it presents with highly variable and non-specific clinical features that frequently resemble autoimmune or other infectious ocular conditions, leading to delayed diagnosis and potential mismanagement. The pathophysiology involves early hematogenous dissemination, endothelial injury, and immune-mediated inflammation, often overlapping with mechanisms seen in neurosyphilis. Ocular involvement may affect virtually all eye structures, with uveitis being the most common presentation, alongside manifestations such as retinitis, vasculitis, optic neuritis, and interstitial keratitis. Diagnosis is made through an increased index of clinical suspicion, based on the results of treponemal and nontreponemal tests. Imaging studies like optical coherence tomography and fluorescein angiography help assess the condition but are not definitive. Management follows neurosyphilis treatment protocols, with intravenous penicillin as the cornerstone of therapy and adjunctive corticosteroids or immunosuppressive agents in selected cases. Given the global resurgence of syphilis and increasing reports of ocular involvement, early recognition and prompt treatment are essential to prevent irreversible visual impairment.]]>
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