Sympathetic Ophthalmia

Sympathetic Ophthalmia

Definition

Specific bilateral inflammation of the uveal tract due to chronic irritation of one eye, caused by a perforating wound to the eye or intraocular surgery, pro-duces transferred uveitis in the fellow eye.

Epidemiology:

Sympathetic ophthalmia is very rare.

Etiology:

Sympathetic uveitis can occur in anotherwise unaffected eyeevenyears after penetrating injuries or intraocular surgery in the fellow eye, especially where there was chronic irritation. Tissues in the injured eye (uveal tract, lens, and retina) act as antigens and provoke an autoimmune dis-order in the unaffected eye.

Symptoms:

The earliest symptoms include limited range of accommodationand photophobia. Later there is diminished visual acuity and pain.

Diagnostic considerations:

Clinical symptoms include combined injections,cells and protein in the anterior chamber and vitreous body, papillary and ret-inal edema, and granulomatous inflammation of the choroid.

Differential diagnosis:

The disorder should be distinguished from iridocyclitis and choroiditis from other causes (see Table 8.1).

Treatment:

The injured eye, which is usually blind, must be enucleated toeliminate the antigen. High-dose topical and systemic steroid therapy is indi-cated. Concurrent treatment with immunosuppressives (cyclophosphamide and azathioprine) may be necessary.

Clinical course and complications:

The disorder has a chronic clinical courseand may involve severe complications of uveitis such as secondary glaucoma,

secondary cataract, retinal detachment, and shrinkage of the eyeball. Sympa-thetic ophthalmia can lead to blindness in particularly severe cases.

When the injured eye is blind, prophylactic enucleation is indicated before the onset of sympathetic ophthalmia in the fellow eye. An early sign of sympathetic ophthalmia is a limited range of accommodation with photophobia.