Acute corneal hydrops secondary to acquired syphilis

Purpose To report a rare case of acute corneal hydrops and conjunctival ulceration secondary to acquired syphilis. Methods A male in his late 30's presented with redness, pain, and watering in both eyes and sudden loss of vision in the left eye. Examination revealed bilateral conjunctival ulcers along with well-circumscribed corneal edema with blunt stunted intrinsic vessel in the left eye. Anterior-Segment Optical Coherence Tomography revealed immense corneal edema with stunted vessels suggestive of acute hydrops. Results Topical moxifloxacin with oral doxycycline was administered along with oral acetazolamide. The patient's serology (VDRL) was positive with Treponema Pallidum Hemagglutination Assay positivity. Intramuscular benzathine penicillin injections (weekly; 3 injections) were given and subsequently, there was complete resolution with corneal scarring and restoration of vision to 20/60 in the left eye. Conclusion This is the first case to illustrate acute hydrops as a presenting sign of ocular syphilis.