Syphilitic Uveitis-Associated Chiasmal Optic Neuritis Presenting As Bitemporal Hemianopia-Like Visual Field Defects.

Syphilis is a systemic infectious disease that can involve both ocular tissues and the central nervous system, with syphilitic uveitis representing one of its ocular manifestations. We report a rare case of syphilitic uveitis occurring in conjunction with chiasmal optic neuritis. A 48-year-old man presented with blurred vision in the right eye and was found to have bilateral acute syphilitic posterior placoid chorioretinitis with vitreous opacity in the left eye. Visual field testing demonstrated bitemporal hemianopia-like defects, and magnetic resonance imaging revealed enhancement of the optic chiasm. Serologic testing confirmed syphilis. Oral amoxicillin therapy resulted in complete resolution of the inflammation and recovery of vision. This case highlights that bitemporal hemianopia in patients with syphilitic uveitis may reflect concurrent chiasmal involvement rather than uveitic pathology alone, underscoring the importance of early diagnosis and appropriate treatment are crucial for achieving favorable visual outcomes.