During her lecture, “Diseases in Disguise: Syphilis, Herpes, and Lyme,” which took place yesterday at 8 a.m., Julie A. Tyler, OD, FAAO, unmasked the ocular indicators of these often-difficult to diagnose conditions.

When asked, Dr. Tyler reported that she hopes her presentation highlights some of the more pronounced aspects of syphilis, Lyme and herpetic infections because each of these conditions are so diverse in their ocular and systemic presentations and often initially overlooked as a condition more commonly encountered. She reinforced that delayed treatment of the conditions often leads to more serious, long-term consequences. 

First things first
To illustrate the importance of case history in arriving at a diagnosis, Dr. Tyler discussed cases where patients presented with symptoms, including persistent red eye and a rash. In both cases, the patients experienced evolving symptoms over time, and discussion with the patients revealed risk factors, such as unprotected sexual contact and residence in a part of the country where Lyme disease is known to be present.

Syphilis 
Syphilis, which Dr. Tyler dubbed “the great imitator,” can manifest ocularly in various ways, from anterior uveitis to optic neuropathy. The presentation highlighted the different stages of syphilis — primary, secondary, latent, and tertiary — each with distinct ocular and systemic manifestations. Diagnostic testing for syphilis usually includes serology, and treatment typically involves penicillin G. 

Herpes
Herpes simplex virus presents with a wide variety of acute presentations and long-term complications, including anterior segment epithelial keratitis, stromal keratitis, endotheliitis, and uveitis, Dr. Tyler noted.

Lyme disease 
Lyme disease, caused by the spirochete Borrelia burgdorferi, presents in three stages, and ocular involvement is possible in all three, but is most common in the second stage, Dr. Tyler pointed out. Specifically, ocular symptoms associated with Lyme include conjunctivitis, keratitis, vitritis, optic neuritis, papillitis, and motility abnormalities, among others.

Dr. Tyler stressed the importance of prompt diagnosis and treatment, particularly for systemic infections with potentially severe ocular sequelae. A thorough case history, especially for those patients not responding to management of an initial diagnosis is essential for best outcomes, she said. OM