Angle-closure glaucoma as a presumed presenting sign in patients with syphilis

Background: Angle-closure glaucoma is a well-known sequel to syphilitic interstitial keratitis. This study describes angle-closure glaucoma in the absence of corneal opacity as a presumed presenting sign of syphilis. Cases: Two patients presented with angle-closure glaucoma with high peripheral anterior synechiae to the level over Schwalbe's line extending the whole circumference of the angle. Neither corneal opacity nor aqueous inflammation was present. Diffuse or localized retinochoroidal degeneration with pigmentation was found in 1 eye of 1 patient and in both eyes of the other patient. Observations: Fluorescein angiography revealed dotty retinal pigment epithelial damage even in normal appearing areas of the fundus. The patients showed a positive test for Treponema pallidum hemagglutination and also a low titer of serological tests for syphilis. No systemic activity, such as skin rashes, had been noted. Conclusions: Syphilis should be considered in patients presenting high peripheral anterior synechiae involving the whole circumference of the angle even in the absence of preceding interstitial keratitis. Copyright (C) 2000 Japanese Ophthalmological Society.