Intrauterine Keratitis: Bacterial and Syphilitic
Infections acquired in utero or during delivery can cause ocular damage in several ways:
through direct action of the infecting agent, which damages tissue
through a teratogenic effect resulting in malformation
through a delayed reactivation of the infectious agent after birth, with inflammation that damages developed tissue
Congenital syphilis is acquired in utero and caused by infection with the spirochete Treponema pallidum. It can lead to fetal death or premature delivery. A variety of systemic manifestations have been widely described. In children with untreated congenital syphilis, onset of interstitial keratitis is typically between 6 and 12 years of age. The keratitis presents as rapidly progressive corneal edema, followed by abnormal vascularization in the deep stroma adjacent to Descemet membrane. The cornea may assume a salmonpink color because of intense vascularization, giving rise to the term salmon patch. Over several weeks to months, blood flow through these vessels gradually ceases, leaving empty “ghost” vessels in the corneal stroma. See Chapter 11 in this volume for a more complete discussion of interstitial keratitis, as well as BCSC Section 6, Pediatric Ophthalmology and Strabismus, for additional discussion of congenital syphilis.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.