[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Ophthalmology](https://durgical.com/en/ophthalmology/) › [The eye in systemic disease](https://durgical.com/en/ophthalmology/areas/systemic/) › Systemic infections in the eye: syphilis, TB, toxoplasma # Systemic infections in the eye: syphilis, TB, toxoplasma - Eye and systemic disease Several systemic infections inflame the eye. Toxoplasmosis is the commonest cause of posterior uveitis in Colombia; syphilis imitates anything. Updated Nov 5, 2026 **See it in 3D:** [Retina](https://durgical.com/en/anatomy/retina/) · [Choroid](https://durgical.com/en/anatomy/choroid/) · [Iris](https://durgical.com/en/anatomy/iris/) · [Optic nerve](https://durgical.com/en/anatomy/optic-nerve/) ## Key points - Commonest posterior uveitis in Colombia: toxoplasmosis. - Syphilis can mimic any eye inflammation: test for it. - Ocular syphilis = treat as neurosyphilis. - Hutchinson sign (tip of the nose) = eye involvement in zoster. ## What it is Many infections reach the eye through the blood or the nerves. In Colombia toxoplasmosis is the commonest cause of retinochoroiditis. Syphilis can cause any type of uveitis or optic neuropathy and must be tested for in almost every unexplained case. Tuberculosis causes choroiditis and uveitis in endemic areas. Herpes zoster can affect the eye through the ophthalmic nerve, and fungi and bacteria can seed the eye from the blood. ## Eye findings - Toxoplasmosis: a focal white retinochoroiditis next to an old pigmented scar, with vitreous haze. - Syphilis: any uveitis, retinitis or optic neuritis; Argyll Robertson pupils in late neurosyphilis. - Tuberculosis: choroidal granulomas, granulomatous uveitis, occlusive vasculitis. - Herpes zoster ophthalmicus: rash on the forehead; a lesion on the tip of the nose predicts eye involvement. - Endogenous endophthalmitis: in patients with central lines, drug injection or bacteraemia. - Toxocariasis: a retinal granuloma or leukocoria in a child exposed to puppies or soil. ## Screening and follow-up - Ocular syphilis is treated as neurosyphilis, and the patient should also be tested for HIV. - Toxoplasma lesions near the macula or optic nerve, or in immunosuppressed patients, are treated; small peripheral ones may resolve alone. - Colombia was the first country certified by WHO as having eliminated onchocerciasis transmission (river blindness). ## Next step / Initial management - Uveitis without a clear cause: syphilis serology, HIV test and, by pattern, tuberculosis tests (interferon-gamma release assay, chest X-ray) and toxoplasma serology. - Ocular syphilis: neurosyphilis treatment with intravenous penicillin and notification. - Herpes zoster ophthalmicus: oral antiviral within 72 hours of the rash and ophthalmology if the eye is red or painful. - Suspected endogenous endophthalmitis: blood cultures, ophthalmology the same day, systemic antimicrobials. ## Test yourself Think of the answer, then tap the question to see it. ## What is the typical appearance of ocular toxoplasmosis? A focal white retinochoroiditis next to an old pigmented scar, with overlying vitreous haze. ## How is ocular syphilis treated? As neurosyphilis, with intravenous penicillin, and with an HIV test. ## What does a zoster lesion on the tip of the nose predict? Eye involvement, because the nasociliary nerve supplies the nose tip and the eye (Hutchinson sign). [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/ophthalmology/systemic-infections-in-the-eye-syphilis-tb-toxoplasma/) ## Connections ## See it in 3D 4 The structures of Durgical's 3D anatomy where it is found. - [Retina](https://durgical.com/en/anatomy/retina/) - [Choroid](https://durgical.com/en/anatomy/choroid/) - [Iris](https://durgical.com/en/anatomy/iris/) - [Optic nerve](https://durgical.com/en/anatomy/optic-nerve/) ## Related 4 - [HIV and the eye: CMV retinitis and more](https://durgical.com/en/ophthalmology/hiv-and-the-eye-cmv-retinitis-and-more/) - [The uvea: iris, ciliary body and choroid](https://durgical.com/en/ophthalmology/the-uvea-iris-ciliary-body-and-choroid/) - [Sarcoidosis and Behçet disease in the eye](https://durgical.com/en/ophthalmology/sarcoidosis-and-behcet-disease-in-the-eye/) - [Leukocoria: the white pupil](https://durgical.com/en/ophthalmology/leukocoria-the-white-pupil/) ## Related conditions 7 - [Ocular toxoplasmosis (retinochoroiditis)](https://durgical.com/en/conditions/ocular-toxoplasmosis/) - [Syphilis](https://durgical.com/en/conditions/syphilis/) - [Tuberculosis](https://durgical.com/en/conditions/tuberculosis/) - [Herpes zoster ophthalmicus](https://durgical.com/en/conditions/herpes-zoster-ophthalmicus/) - [Toxocariasis (visceral and ocular larva migrans)](https://durgical.com/en/conditions/toxocariasis/) - [Onchocerciasis (river blindness)](https://durgical.com/en/conditions/onchocerciasis/) - [Endophthalmitis](https://durgical.com/en/conditions/endophthalmitis/) [← All of ophthalmology](https://durgical.com/en/ophthalmology/) Educational content; not a clinical guideline and no substitute for assessment by a health professional. For sudden visual loss, severe eye pain, a chemical burn or an eye injury, go to an emergency department at once. Sources: [Syphilis Ocular Manifestations](https://www.ncbi.nlm.nih.gov/books/NBK558957/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Ocular Tuberculosis](https://www.ncbi.nlm.nih.gov/books/NBK559303/) (StatPearls Publishing (NCBI Bookshelf), 2024); [Toxoplasmosis](https://www.ncbi.nlm.nih.gov/books/NBK563286/) (StatPearls Publishing (NCBI Bookshelf), 2024); [Herpes Zoster Ophthalmicus](https://www.ncbi.nlm.nih.gov/books/NBK557779/) (StatPearls Publishing (NCBI Bookshelf), 2025); [Onchocerciasis: fact sheet](https://www.who.int/news-room/fact-sheets/detail/onchocerciasis) (World Health Organization, 2022). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/ophthalmology/systemic-infections-in-the-eye-syphilis-tb-toxoplasma/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/ophthalmology/systemic-infections-in-the-eye-syphilis-tb-toxoplasma/