The Eye.
—Of the manifestations of syphilis in particular organs the eye sometimes suffers severely. Iritis is the most common and serious manifestations of constitutional syphilis. It has been estimated that nearly 60 per cent. of all cases of iritis are due to this cause. It may occur in two months after the primary sore; it is usually acute, and rarely begins in both eyes at the same time, but may involve one after the other. The ciliary body is frequently associated in the lesion, and iridocyclitis occurs. It commences with congestion of the conjunctiva, photophobia, and lacrymation. The pain is not always severe. Inspection of the iris will show beads of lymph, a small pupil, with loss of contractility, or the dull iris may appear infiltrated and inflexible. The pain in some cases is extreme. Where treatment has been only partially effective relapses are common. The greatest danger to be feared is formation of adhesions between the anterior surface of the lens and the margin of the pupil, i. e., anterior synechiæ. These are detrimental, and serve as the cause of many irritations.
The treatment of these affections is constitutional; locally solutions of atropine of sufficient strength to ensure dilatation of the pupil should be used, not only to relieve the pain, but to carry the margin of the pupil from the central portion of the lens and prevent adhesions. The patients should be kept in the dark because of their photophobia. Atropine may be substituted by duboisine if the former tends to produce congestion. Leeches applied to the temples will also give relief from pain.
The cornea is often affected by a deposit on its posterior surface of particles of debris, which give it a punctate appearance known as keratitis punctata. It also becomes the seat of opacities which materially interfere with vision, and prove only partially amenable to treatment. Lesions of the cornea are frequent in hereditary syphilis.
Retinitis and choroiditis, of either acute or chronic type, are the most common syphilitic lesions of the fundus. They are usually associated and involve both eyes. They come on so insidiously that they are often far advanced when first discovered. The lesions consist of patches of exudation and areas of atrophy, accompanied by some haziness in the vitreous. Vision is affected in proportion to the area involved.
The movements of the eyes are interfered with by lesions which pertain, however, rather to the brain and the ocular nerves than to the eye itself. The sixth nerve, lying on the floor of the skull, is affected by syphilitic disease at the base of the bone. As a result of these nerve lesions paralysis is often seen, or at least disturbances of motility from which diplopia results. Ptosis occurs from affection of the third nerve. In lesions situated below the aqueduct of Sylvius, the paralytic condition which Hutchinson has spoken of as ophthalmoplegia is likely to appear. Optic neuritis is also a late manifestation of syphilis, and may be either chronic and mild, with a small disturbance of vision, or acute, with rapid loss of eyesight.
The Ear.
—The ear may suffer in various ways. The external ear may participate in affections of the adjoining skin. The middle ear may be affected as a result of extension of trouble from the nasopharynx, while in the late stages of the disease patients may suffer from labyrinthine disease, with partial or almost total deafness.
The Nose.
—The lesions of syphilis in the nose are numerous and offensive. Ulceration is frequent and followed by perforation through the septum or into the mouth. When the vomer is involved the bridge of the nose falls in. In neglected cases the whole substance of the nose may be involved and subsequently lost. The bone is often exfoliated. These ulcerations of the mucous membrane and periosteum give rise to a characteristic condition known as ozena, with its characteristic discharge.