Syphilitic Keratitis

Types
Causes
Symptoms
Diagnostic tests
Non-pharmacological treatments (therapies and “other”)
Drug treatments
Dietary “molecular” supplements
Regenerative,” or “stem-cell drugs
Surgeries
Prevention tips
When to see a doctor
What to eat and what to avoid
Frequently Asked Questions

Syphilitic keratitis means inflammation of the clear front window of the eye (the cornea) that is caused by the infection called syphilis. Syphilis is an infection by a spiral-shaped germ called Treponema pallidum. The germ can enter the body through sexual contact or can pass from a mother to her baby during pregnancy. The cornea is normally clear and has no blood vessels. In syphilitic keratitis, the middle layer of the cornea (the stroma) becomes inflamed and swollen. Small new blood vessels can grow into the cornea from the edge to bring in immune cells; doctors often call this “interstitial keratitis.” When the stroma swells and vessels grow, the cornea loses its glass-like clarity. Light cannot pass cleanly, so vision becomes foggy and the eye becomes painful and sensitive to light. Some people have syphilitic keratitis in childhood because of congenital (from birth) syphilis. Others develop it as adults when syphilis affects the eyes. The main idea is simple: the syphilis germ and the body’s immune reaction disturb the calm, clear cornea, and this disturbance causes redness, pain, and cloudy vision.

Syphilitic keratitis means inflammation and scarring of the clear front window of the eye (the cornea) caused by syphilis. Syphilis is an infection by a spiral-shaped bacterium called Treponema pallidum. When syphilis reaches the eye, doctors treat it the same way they treat neurosyphilis (syphilis involving the brain or nerves), because the eye is considered part of the nervous system for treatment decisions. Antibiotics that kill T. pallidum are essential; eye drops and other measures only help with comfort and inflammation after the bacteria are controlled. Early, correct treatment prevents pain, scarring, and vision loss. CDCAmerican Academy of OphthalmologyNCBI

The disease can be active (with redness, pain, and haze) or quiet (no pain, but old “ghost” blood vessels and thin, scarred areas remain). Syphilitic keratitis can involve one eye first and then the other eye later. It can also occur together with inflammation inside the eye (uveitis), inflammation of the white coat of the eye (scleritis), or with problems of the retina and optic nerve in more extensive “ocular syphilis.” Prompt diagnosis and correct antibiotic treatment for syphilis are essential to protect sight and protect overall health.

Types

Congenital interstitial keratitis (from birth)
This type appears in children or young adults who were exposed to syphilis before birth. The cornea shows deep haze and fine blood vessels, and attacks may come in “episodes.” Old vessels can empty later and become “ghost vessels,” which are pale lines inside the cornea that show where active vessels used to be.
Acquired syphilitic keratitis (after infection in life)
This type happens in a person who caught syphilis later. The eye becomes red, painful, and very light sensitive. It can be the first visible sign that syphilis is present in the body.
Active interstitial keratitis
Here the cornea is hot and inflamed. There is pain, tearing, and glare. New fine vessels creep into the cornea from the edge. The cornea looks hazy like frosted glass.
Quiescent (healed) interstitial keratitis
Pain and redness are gone, but the cornea keeps the marks of past disease: faint haze, thin patches, and ghost vessels. Vision may still be reduced, especially if scarring crosses the visual axis.
Diffuse stromal keratitis
The swelling and haze spread widely across the cornea. The whole cornea can look grey or milky. Vision drops more because a larger area is affected.
Nodular stromal keratitis
The swelling forms lumps or nodules inside the cornea. These lumps distort light and can leave scars when they heal.
Disciform (round-disk) keratitis
A round, coin-shaped area of swelling forms in the back part of the cornea. The edges are steep and clear-cut. This pattern also occurs in other diseases, so doctors use tests to confirm syphilis.
Unilateral then bilateral disease
The disease often starts in one eye and later involves the other eye. This “switching sides” pattern is typical for interstitial keratitis, especially in congenital cases.
Syphilitic keratitis with anterior uveitis
Inflammation spills into the front chamber of the eye. There may be cells and flare in the fluid, and sometimes small inflammatory deposits on the back of the cornea.
Syphilitic keratitis with scleritis or episcleritis
The white coat of the eye becomes tender and inflamed along with the cornea. Pain can be deeper and more severe.

Causes

Below are causes and contributing factors that lead to syphilitic keratitis or make it more likely to appear or flare. Each item is explained in plain language.

Congenital syphilis (infection before birth)
A baby exposed to T. pallidum in the womb can later develop interstitial keratitis in childhood or adolescence because the immune system reacts to old treponemal antigens in the cornea.
Acquired syphilis in adulthood
When a person catches syphilis, the germ can spread through the bloodstream to many organs, including the eyes, and trigger corneal inflammation.
Secondary syphilis (immune-rich stage)
During secondary syphilis, many immune complexes circulate. They can settle in the cornea and start stromal inflammation.
Tertiary syphilis (late disease)
In late disease, the body mounts strong delayed-type immune reactions. This can involve the cornea and cause deep interstitial keratitis or gummatous inflammation nearby.
Latent syphilis that reactivates
Even when there are no outward signs, syphilis may still be present. Reactivation can lead to new eye inflammation.
Inadequate or delayed antibiotic treatment
If syphilis is not treated, or treatment is late or incomplete, the risk of ocular disease including keratitis is higher.
Re-infection with syphilis
A second infection restarts immune activity and can bring new eye disease.
HIV co-infection or other immune weakness
When the immune system is altered, syphilis behaves more aggressively and is more likely to involve the eyes.
Immune cross-reaction in the cornea
Proteins from the syphilis germ can look similar to corneal proteins. The body’s defense can attack the cornea by mistake and cause interstitial keratitis.
Syphilitic inflammation of small blood vessels at the corneal edge
Syphilis can inflame tiny vessels around the cornea (limbus). The damaged vessels and nearby tissue fuel new vessel growth into the cornea and start stromal swelling.
Old congenital disease that flares at puberty
Classic congenital interstitial keratitis can relapse in teenage years because hormonal and immune changes “wake up” silent inflammation.
Ocular syphilis with anterior uveitis
Inflammation from inside the eye can affect the cornea, leading to secondary stromal haze and sensitivity.
Syphilitic scleritis or episcleritis spreading to the cornea
When the white coat is inflamed by syphilis, the reaction can extend to the clear cornea and trigger keratitis.
Neurotrophic surface from syphilitic nerve involvement
Syphilis can injure nerves. When the cornea becomes less sensitive, the surface becomes unhealthy and more prone to sterile inflammation.
High treponemal load during early systemic spread
When many germs circulate early in infection, the chance that the eye becomes involved increases.
Poor access to care
Delayed diagnosis of syphilis allows the infection to progress and raises the risk of ocular involvement, including corneal disease.
Penicillin allergy with suboptimal alternatives or poor adherence
If first-line therapy is not used or doses are missed, control of syphilis may be weaker, and ocular problems can appear or persist.
Local trauma in a person with active syphilis
Minor corneal injury can “unmask” antigens and trigger or worsen stromal inflammation in the setting of active infection.
Pregnancy with untreated maternal syphilis
Maternal infection can lead to congenital infection and later interstitial keratitis in the child.
Blood-borne spread to ocular tissues
Early in infection, germs reach the eye via the bloodstream and set the stage for future corneal inflammation.

Symptoms

Eye redness
The white of the eye looks pink or red because surface blood vessels swell from inflammation.
Eye pain or deep ache
There can be a gritty pain on the surface and a deeper, dull ache around the eye due to swelling and nerve irritation.
Light sensitivity (photophobia)
Bright light feels harsh or painful because the inflamed cornea lets scattered light hit the iris and ciliary body.
Tearing and watery discharge
The eye makes more tears to protect the irritated surface, so tears run down the cheek.
Blurred or cloudy vision
The swollen cornea acts like frosted glass, so images look smeared or dim.
Glare and halos around lights
At night or in bright rooms, rings or rays appear around lights because the cornea scatters light.
Foreign-body sensation
It feels as if sand or an eyelash is stuck in the eye because the surface is rough and inflamed.
Brow ache or headache
Muscles around the eye overwork to avoid light and to focus through haze, leading to a heavy brow ache.
Difficulty with night driving
Halos and glare make headlights hard to tolerate, so night vision feels unsafe.
Reduced contrast and color clarity
Whites look dingy and colors look dull because light transmission is poor.
Intermittent double or ghost images
Irregular swelling can change the cornea’s shape, causing ghosting or shadow images.
Eye fatigue
Reading or screen work tires the eyes quickly because they strain to see through the haze.
Lid spasm (blepharospasm)
The eyelids squeeze shut against light and pain, especially outdoors.
Mild sticky feeling on waking
Tears and surface debris can dry at night, so the lids feel slightly stuck in the morning.
Symptoms in one eye, then the other
The disease may start on one side and weeks or months later affect the other side, which can be confusing for patients.

Diagnostic tests

(Grouped as Physical Exam, Manual Tests, Lab/Pathological Tests, Electrodiagnostic Tests, and Imaging Tests. Each test is explained in very simple language.)

Physical Exam

Visual acuity test (reading letters on a chart)
This basic test measures how clearly each eye sees. It shows how much the corneal haze reduces vision and helps track improvement after treatment.
External eye inspection with a bright light
The doctor looks at the eyelids, lashes, conjunctiva, and the overall shine of the cornea. Redness, swelling, and loss of corneal sparkle suggest active inflammation.
Slit-lamp biomicroscopy
A microscope with a narrow beam shows the cornea in fine detail. The doctor can see stromal haze, fine blood vessels growing from the edge, nodules, “ghost vessels,” and any deposits on the back of the cornea. This is the key exam for interstitial keratitis.
Fluorescein dye staining with cobalt-blue light
A safe orange dye outlines surface defects. In syphilitic keratitis the surface may be mostly intact, but staining can reveal rough spots or small erosions. It also helps rule out other causes like herpes epithelial ulcers.
Intraocular pressure (IOP) measurement
A gentle device (often a blue-light applanation tip) touches the numbed cornea to measure eye pressure. Pressure can change if there is accompanying uveitis or steroid response, so measuring it is important.
Pupil reactions and RAPD check
The doctor shines light to see if pupils react equally. An abnormal response can suggest deeper eye involvement beyond the cornea, prompting broader testing for ocular syphilis.

Manual Tests

Corneal sensitivity test (cotton wisp or Cochet-Bonnet esthesiometer)
A soft wisp or a thin nylon filament touches the cornea to check feeling. Reduced sensation points to surface nerve dysfunction and helps separate diagnoses.
Digital palpation for IOP (very gentle finger estimate)
If standard tonometry is not available, the doctor can very gently compare firmness of the two eyes with closed lids. It is a rough guide only but can signal pressure problems that need attention.
Eyelid eversion and fornix sweep
The lid is flipped to inspect for hidden debris or membrane. While not specific to syphilis, it rules out added irritants that could worsen surface inflammation.
Confrontation visual field test
The patient covers one eye and counts the examiner’s fingers in different areas. Field loss would prompt deeper evaluation for posterior eye involvement.

Lab and Pathological Tests

Non-treponemal blood test (RPR or VDRL)
These screening tests measure antibodies that rise with active syphilis. They also give a titer number that helps judge how active the infection is and how it responds to treatment over time.
Treponemal-specific blood test (FTA-ABS)
This confirmatory test detects antibodies that specifically recognize T. pallidum. Once positive it often stays positive for life, so it proves exposure.
TP-PA or treponemal EIA/CIA
These are other treponemal-specific tests used to confirm the diagnosis. Labs often run a modern treponemal assay first and then add RPR/VDRL for activity.
Cerebrospinal fluid (CSF) tests when neurosyphilis is suspected
A lumbar puncture can check CSF-VDRL, cell count, and protein. Eye involvement, especially with uveitis or nerve findings, often triggers CSF testing to guide the antibiotic plan.
HIV testing
Because HIV changes the course of syphilis and eye disease, testing helps the team choose the safest and most effective treatment and follow-up schedule.
PCR or dark-field examination when lesions are accessible
If there is a fresh chancre or other lesion, special tests can directly detect T. pallidum. In select cases, PCR from aqueous or vitreous fluid is considered in specialty centers.

Electrodiagnostic Tests

Visual evoked potential (VEP)
Small electrodes record the brain’s response to patterned light. If vision is poor and the cause is unclear, VEP helps decide how much of the problem is in the cornea versus deeper in the visual pathway.
Electroretinography (ERG)
ERG measures the retina’s electrical response. It is usually normal in isolated corneal disease but is helpful if ocular syphilis is suspected beyond the cornea.

Imaging Tests

Anterior segment optical coherence tomography (AS-OCT)
This painless scan shows “slices” of the cornea. It measures how thick the stroma is, where the swelling sits, and whether there is a sharp disc-shaped pattern. It helps follow healing over time.
Ultrasound biomicroscopy (UBM) or anterior segment ultrasound
High-frequency ultrasound draws a picture of the front of the eye. It can show hidden swelling or peripheral inflammation when the view is poor at the slit lamp.

Non-pharmacological treatments (therapies and “other”)

(Each item explains the description, purpose, and mechanism in plain English.)

Immediate referral to an eye specialist and an STI clinic
Description: As soon as syphilis is suspected in the eye, you see an ophthalmologist and also an STI specialist.
Purpose: To confirm the diagnosis and start the right antibiotic right away.
Mechanism: Coordinated care ensures you receive neurosyphilis-level therapy (IV penicillin) and eye-specific care together, which prevents vision loss. CDCAmerican Academy of Ophthalmology
Avoid contact lenses until fully quiet
Description: Stop wearing contacts during active inflammation and while medicines are adjusted.
Purpose: Reduce friction, infection risk, and extra inflammation.
Mechanism: A bare cornea heals better and stays cleaner.
Protective eyewear and sunglasses
Description: Wear wraparound sunglasses outdoors.
Purpose: Reduce light sensitivity and irritation from wind/dust.
Mechanism: Less UV and wind exposure calms surface nerves and tear evaporation.
Preservative-free artificial tears (supportive, not a “drug” treatment for syphilis)
Description: Sterile, single-use lubricating drops.
Purpose: Soothe burning and light sensitivity.
Mechanism: Dilute inflammatory molecules on the cornea and help the surface glide.
Cool compresses for comfort
Description: Clean, cool cloth over closed eyelids for 5–10 minutes.
Purpose: Calm pain and swelling.
Mechanism: Mild local cooling reduces superficial nerve firing and inflammation.
Rest the eyes during flare-ups
Description: Short screen breaks, dimmer ambient light.
Purpose: Reduce eye strain and photophobia.
Mechanism: Fewer triggers for corneal nerves = less pain.
Strict sexual-health measures
Description: Use condoms correctly, avoid sex until your clinician says you’re no longer infectious, and notify partners.
Purpose: Prevent spreading syphilis and reinfecting yourself.
Mechanism: Interrupts transmission of T. pallidum; partner therapy reduces recurrence risk. CDC
Partner testing and treatment
Description: Recent sexual partners are examined and treated.
Purpose: Stop ping-pong infection.
Mechanism: Breaks the chain of transmission. CDC
Prenatal screening and treatment (for those who can become pregnant)
Description: Early pregnancy syphilis screening and immediate penicillin if positive.
Purpose: Prevent congenital syphilis and later interstitial keratitis in the child.
Mechanism: Treating the mother cures the infection and protects the fetus. CDC
Avoid topical anesthetic self-use
Description: Do not use numbing drops at home.
Purpose: They can silently damage the cornea.
Mechanism: Local anesthetics slow healing and increase risk of ulcers.
Smoking cessation
Description: Stop tobacco and vaping.
Purpose: Reduce ocular surface inflammation and vascular problems.
Mechanism: Less oxidative stress → better corneal healing.
Tear-film hygiene
Description: Gentle lid hygiene with sterile wipes if advised.
Purpose: Optimize tear quality.
Mechanism: A clean lid margin reduces inflammatory load reaching the cornea.
Nutritional support (see supplements below for details)
Description: Balanced diet with adequate protein, vitamins, and omega-3s.
Purpose: Support tissue repair and immune balance.
Mechanism: Provides building blocks for collagen and antioxidant defense.
Goggles in dusty or windy environments
Description: Wear moisture-chamber goggles if you must be outside.
Purpose: Minimize irritation and dryness.
Mechanism: Creates a humid micro-environment around the eyes.
Sleep and stress management
Description: Aim for regular sleep and basic relaxation techniques.
Purpose: Better immune regulation and pain control.
Mechanism: Sleep helps cytokine balance; stress raises pain sensitivity.
Written flare action plan
Description: Know exactly whom to call and what to do if redness/pain returns.
Purpose: Prompt care prevents scarring.
Mechanism: Early evaluation → timely medicine adjustments.
Avoid eye rubbing
Description: Keep hands off the eyes.
Purpose: Prevent micro-trauma and extra inflammation.
Mechanism: Rubbing drives inflammatory cells into the cornea.
Allergy-control environment
Description: Reduce dust mites, use air filters if allergic.
Purpose: Less background irritation during recovery.
Mechanism: Lower mast-cell activity → calmer surface.
Adherence tools
Description: Use phone alarms and drop charts.
Purpose: Ensure no missed antibiotic doses.
Mechanism: T. pallidum is cleared reliably only with fully completed courses. CDC
Education on Jarisch–Herxheimer reaction (JHR)
Description: A short-term worsening right after starting antibiotics (fever, aches, sometimes temporary eye inflammation).
Purpose: So you don’t panic and you call your clinician promptly.
Mechanism: As bacteria die, they trigger a surge of inflammatory molecules; eye findings can briefly worsen then settle with supportive care. PMC

Drug treatments

(Each item lists drug class, typical dosage/time, purpose, mechanism, key side effects. Doses are typical adult ranges; clinicians individualize. Do not self-medicate.)

Aqueous crystalline penicillin G (gold-standard antibiotic for ocular syphilis)
Class: Beta-lactam antibiotic (penicillin).
Dosage/Time: 18–24 million units/day IV as 3–4 million units every 4 hours or continuous infusion for 10–14 days.
Purpose: First-line to cure ocular syphilis (treated as neurosyphilis).
Mechanism: Blocks bacterial cell-wall synthesis, killing T. pallidum.
Side effects: Allergic reactions, infusion-related issues, JHR early in therapy. CDCAmerican Academy of Ophthalmology
Procaine penicillin G + probenecid (when IV access isn’t feasible and adherence is assured)
Class: Penicillin + uricosuric that raises penicillin levels.
Dosage/Time: Procaine penicillin G 2.4 million units IM daily + probenecid 500 mg orally four times daily for 10–14 days.
Purpose: CDC-listed alternative regimen.
Mechanism: Maintains bactericidal penicillin concentrations in the nervous system.
Side effects: Injection-site pain, allergic reactions, GI upset from probenecid. CDC
Ceftriaxone (alternative if severe penicillin allergy; clinician-judged)
Class: Third-generation cephalosporin.
Dosage/Time: 1–2 g IM/IV once daily for 10–14 days.
Purpose: Alternative regimen; cross-reactivity risk with penicillin is low but considered.
Mechanism: Inhibits bacterial cell-wall synthesis.
Side effects: Allergy, biliary sludging, diarrhea; JHR can still occur. CDCNCBI
Benzathine penicillin G “completion doses” (for total duration after neurosyphilis course, at clinician discretion)
Class: Long-acting penicillin.
Dosage/Time: 2.4 million units IM weekly for 1–3 weeks after finishing an approved neurosyphilis regimen, to match the longer duration used for latent syphilis.
Purpose: Ensures adequate total exposure when indicated.
Mechanism: Prolonged low-level bactericidal penicillin.
Side effects: Injection pain, allergy. CDC
Topical corticosteroid eye drops (e.g., prednisolone acetate 1%) — only after antibiotics are started
Class: Anti-inflammatory steroid.
Dosage/Time: Often four times daily up to hourly, then slow taper per the ophthalmologist.
Purpose: Quiet the interstitial keratitis inflammation and reduce scarring.
Mechanism: Suppresses immune cells and cytokines in the cornea.
Side effects: Raised eye pressure (glaucoma risk), cataract with long use, infection flare if used before antibiotics. American Academy of OphthalmologyEyeWiki
Cycloplegic drops (e.g., homatropine 5% or atropine 1%)
Class: Antimuscarinic mydriatic.
Dosage/Time: Typically BID–TID short-term.
Purpose: Relieve ciliary spasm pain and prevent iris-to-lens sticking (synechiae).
Mechanism: Temporarily relaxes the focusing muscle and keeps the pupil wide.
Side effects: Blurry near vision, light sensitivity, dry mouth.
IOP-lowering drops if pressure is high (e.g., timolol, brimonidine, carbonic anhydrase inhibitors)
Class: Beta-blocker, alpha-agonist, CAI (topical).
Dosage/Time: Usually BID, individualized.
Purpose: Protect the optic nerve if steroids or inflammation raise pressure.
Mechanism: Decrease aqueous humor production and/or increase outflow.
Side effects: Timolol can cause fatigue/bradycardia; brimonidine may cause allergy/redness; CAIs can sting.
Topical calcineurin inhibitors for steroid-sparing (e.g., cyclosporine 0.05%–0.1%, tacrolimus 0.02%–0.1% off-label)
Class: Local immunomodulators.
Dosage/Time: BID if chosen in recurrent or steroid-dependent cases.
Purpose: Maintain quiet eyes while reducing steroid load.
Mechanism: Blocks T-cell activation driving corneal inflammation.
Side effects: Temporary burning; tacrolimus may be used when steroids raise pressure. EyeWikiPMC
Systemic analgesics (e.g., acetaminophen or clinician-approved NSAIDs)
Class: Pain relievers.
Dosage/Time: Short courses as needed.
Purpose: Ease pain during the first days of treatment or during JHR.
Mechanism: Central pain modulation; NSAIDs also reduce prostaglandins.
Side effects: NSAIDs can irritate the stomach or kidneys; follow medical advice.
Antihistamine/mast-cell stabilizer eye drops (adjunct only)
Class: Anti-allergy drops (e.g., ketotifen).
Dosage/Time: BID if allergic itch worsens comfort.
Purpose: Reduce background itch and rubbing.
Mechanism: Blocks histamine effects on the ocular surface.
Side effects: Mild stinging; not a treatment for syphilis itself.

Important: Doxycycline and other oral alternatives used for early syphilis do not replace neurosyphilis/ocular-syphilis regimens. Penicillin desensitization is advised when true penicillin allergy exists. Follow your specialist’s plan. CDC

Dietary “molecular” supplements

These do not treat syphilis. They may support surface comfort or healing after proper antibiotics are started. Always ask your clinician, especially if pregnant, on blood thinners, or with kidney/liver disease.

Omega-3 (fish-oil EPA+DHA 1–2 g/day)
Supports a healthier tear film and may calm surface inflammation.
Vitamin D3 (1,000–2,000 IU/day unless your clinician prescribes differently)
Helps immune balance; deficiency is common.
Vitamin C (500–1,000 mg/day)
Antioxidant that supports collagen and wound repair.
Vitamin A (dietary sources best; avoid high supplements unless prescribed)
Needed for a healthy ocular surface; excess can be toxic.
Lutein (10 mg/day) and Zeaxanthin (2 mg/day)
Carotenoids that concentrate in ocular tissues and provide antioxidant support.
Zinc (8–11 mg/day from diet; avoid high-dose pills unless advised)
Cofactor for healing enzymes; do not exceed safe upper limits without supervision.
N-Acetylcysteine (600–1,200 mg/day)
Boosts glutathione, a major antioxidant; sometimes used topically (by prescription) for mucus strands.
Probiotics (10–20 billion CFU/day)
May help gut tolerance during systemic antibiotics; choose reputable brands.
Curcumin (500–1,000 mg/day with piperine unless contraindicated)
Anti-inflammatory properties; check for drug interactions.
Collagen peptides (as directed on product)
Provide amino acids that corneal stroma uses during remodeling.

Regenerative,” or “stem-cell drugs

Transparency first: There are no approved “hard immunity booster,” regenerative, or stem-cell drugs for syphilitic keratitis. Recommending such products would be unsafe. I can’t list non-existent or unapproved drugs. Instead, here are safer, evidence-aligned adjuncts or biologic options your specialists may consider in select cases:

Penicillin desensitization (hospital protocol)
Dosage/Function/Mechanism: Carefully raises tolerance to penicillin so you can receive the curative first-line drug despite allergy; enables standard therapy. CDC
Antiretroviral therapy (ART) if you have HIV
Function/Mechanism: Restores immune function and reduces risk of severe or recurrent ocular syphilis; coordinated with infectious-disease care. CDC
Autologous serum tears (biologic eye drops, off-label)
Dosage: Often 20%–50% serum in sterile saline, QID or more, supervised.
Function/Mechanism: Contains growth factors and vitamins that can soothe persistent surface defects once infection is controlled.
Platelet-rich plasma (PRP) eye drops (off-label)
Function/Mechanism: Concentrates platelet-derived growth factors to aid epithelial healing in stubborn surface problems.
Topical calcineurin inhibitors (cyclosporine/tacrolimus) as steroid-sparing maintenance
Function/Mechanism: Reduce T-cell–driven corneal inflammation in recurrent interstitial keratitis. (Included above under drugs; repeated here to emphasize the “steroid-sparing” role.) EyeWikiPMC
Amniotic membrane (as an office procedure, not a “drug”)
Function/Mechanism: Biologic bandage with anti-inflammatory and pro-healing factors to help stubborn epithelial defects after infection control.

If you see “stem-cell drops” or “immunity booster shots” advertised for syphilitic keratitis, be cautious and ask your specialist—these are not approved standards of care.

Surgeries

Deep Anterior Lamellar Keratoplasty (DALK)
What: Replaces scarred front corneal layers while keeping your own endothelium.
Why: Improves vision when interstitial keratitis leaves dense stromal scars but the innermost layer is healthy.
Penetrating Keratoplasty (full-thickness corneal transplant)
What: Replaces the entire cornea.
Why: For severe full-thickness scarring or repeated failures. Infection must be fully treated first. EyeWiki
Phototherapeutic Keratectomy (PTK)
What: Laser “polishing” of superficial scars.
Why: For shallower opacities or surface irregularity causing glare.
Amniotic membrane transplantation
What: A biological membrane is placed on the cornea.
Why: Helps persistent epithelial defects and calms inflammation during healing.
Glaucoma surgery (trabeculectomy or drainage implant) — if needed
What: Creates a new fluid pathway from the eye.
Why: For pressure damage not controlled by drops, especially after steroid use or uveitis-related angle damage.

Prevention tips

Use condoms correctly every time with new or non-monogamous partners. CDC
Get routine STI screening if you have risk factors; test more often if you or your partner have other partners. CDC
Avoid sex until your clinician says you’re non-infectious and your treatment is complete. CDC
Tell and treat partners to avoid reinfection. CDC
Prenatal screening early in pregnancy and immediate treatment if positive. CDC
Consider HIV testing, because co-infection changes follow-up needs. CDC
Don’t share sex toys (or clean properly with condoms on toys).
Limit alcohol and avoid recreational drugs that impair judgment around safer sex.
Keep vaccination and general health up to date (no vaccine for syphilis yet, but overall health supports recovery).
Learn the signs of eye involvement (pain, light sensitivity, floaters, sudden blur) and seek care promptly.

When to see a doctor

Immediately (same day) if you have eye pain, severe light sensitivity, a sudden drop in vision, new floaters/flashes, or a very red eye—especially if you’ve ever been told you have syphilis or have a new rash or sores.
Immediately if you start antibiotics for syphilis and your eyes suddenly worsen—this might be a Jarisch–Herxheimer reaction, which needs prompt guidance but is usually temporary. PMC
Promptly if you are pregnant or could be pregnant and test positive for syphilis. Early treatment protects the baby. CDC
Soon after any syphilis diagnosis, even if your eyes feel normal—everyone with syphilis can develop eye disease, and an exam can catch early signs. NCBI

What to eat and what to avoid

What to eat (5):

Lean proteins (fish, eggs, legumes) to supply collagen-building amino acids.
Colorful vegetables and fruits for antioxidants (vitamins A, C, E, carotenoids).
Omega-3 sources (fatty fish, flax, walnuts) to support a calmer surface.
Whole grains and fiber to steady energy while you recover.
Adequate fluids (water first) to keep tears and mucous membranes healthy.

What to avoid (5):

Smoking and vaping (they worsen surface inflammation).
Excess alcohol, which dehydrates and can worsen adherence to care.
Heavily processed salty foods that may worsen dry eye symptoms in some people.
High-dose vitamin A supplements unless prescribed (toxicity risk).
Self-medicating with “immune boosters”—they won’t treat syphilis and can interact with medicines.

Frequently Asked Questions

1) Is syphilitic keratitis contagious through tears?
No. The infection is sexually transmitted (and from mother to baby during pregnancy). The eye inflammation is your immune response to the germ in your body. The way to stop spread is treating you and your partners. CDC

2) Does everyone with syphilis get eye problems?
No, but syphilis can involve any eye structure, and posterior uveitis and panuveitis are common when the eye is involved. An exam is wise for anyone with syphilis. NCBI

3) What is the best antibiotic for syphilitic keratitis?
Penicillin G given by vein for 10–14 days is the standard for ocular syphilis (managed as neurosyphilis). CDCAmerican Academy of Ophthalmology

4) I’m allergic to penicillin—am I out of options?
Not necessarily. Desensitization allows many people to receive penicillin safely. Ceftriaxone can be considered in some cases. Your specialists will decide. CDC

5) Why can my eye get worse after the first antibiotic doses?
That may be Jarisch–Herxheimer reaction—a short, temporary flare when bacteria die and release inflammatory contents. Contact your doctor; it usually settles with supportive care. PMC

6) When do steroids fit in?
After antibiotics are started, steroids can calm corneal inflammation and reduce scarring. Using them before antibiotics risks worsening infection-related inflammation. American Academy of Ophthalmology

7) Can eye drops alone cure this?
No. Only systemic antibiotics cure syphilis. Eye drops treat symptoms and inflammation. CDC

8) Will I need a corneal transplant?
Most patients improve with timely treatment. A transplant is considered only if dense scars remain that block vision after the eye is quiet. EyeWiki

9) How will my doctors monitor me?
They follow your vision, eye pressure, inflammation, and repeat syphilis blood tests to confirm response. Infectious-disease and eye teams work together. CDC

10) Can syphilitic keratitis return?
Relapses can happen, especially if re-exposed or if inflammation reignites. Prevention, partner treatment, and careful tapering of steroids help. CDC

11) Is congenital interstitial keratitis still seen?
Yes, usually in older children or teens if congenital syphilis wasn’t treated early. It’s part of Hutchinson’s triad with hearing loss and dental changes. Wikipedia

12) Can I keep working during treatment?
Often yes, but you may need light-sensitivity accommodations, frequent breaks, and time for IV therapy visits.

13) What about driving?
Avoid driving if vision is blurry, if lights cause pain, or right after dilating or cycloplegic drops.

14) Do supplements replace antibiotics?
Never. Supplements are supportive only. Antibiotics are essential to cure syphilis. CDC

15) How quickly should I feel better?
Eye comfort often improves within days to weeks after correct therapy, but scarring can take months to stabilize. Your doctor guides tapering and follow-ups.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: August 27, 2025.

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