Sympathetic ophthalmia: A comprehensive update

Abstract

Sympathetic ophthalmia is a rare, bilateral, granulomatous, panuveitis following penetrating trauma or surgery to one eye. Clinical presentation commonly occurs within the first year of trauma occurrence but can be delayed by several years. It manifests as acute/chronic granulomatous uveitis with yellowish-white choroidal lesions or Dalen–Fuchs nodules. Initially, patients respond rapidly to corticosteroid therapy, but a majority require long-term use of corticosteroid-sparing agents to prevent recurrences. The purpose of this review is to elaborate on the current understanding of the pathophysiology, the importance of multimodal imaging in early diagnosis, and the role of newer immunomodulatory and biological agents in recalcitrant cases.

Presumed sympathetic ophthalmia following scleral buckling surgery: A case report and review of the literature

“…Specifically, vitrectomy is the technique most associated with SO, 7 with an incidence ranging from 0.01% to 1%. 8 The risk to develop SO after SB is considered to be significantly lower if compared to vitrectomy as intraocular structures remain relatively isolated from the conjunctiva if no external drainage manoeuvres are performed.…”

“…Indeed, multiple surgeries have been linked to an increased risk of developing the disease. 8 Prompt administration of immunomodulatory therapy is crucial to achieve anatomical resolution of SO and to prevent potentially irreversible vision loss. In this regard, Tan et al found good visual outcomes in a cohort of SO patients treated with early systemic and regional corticosteroid therapy, followed by long-term stepwise use of immunosuppressive drugs.…”

“…Specifically, vitrectomy is the technique most associated with SO, 7 with an incidence ranging from 0.01% to 1%. 8…”

Review of Surgical Techniques in Evisceration

“…It was once debatable whether evisceration is contraindicated in penetrating ocular injury due to the potential risk of sympathetic ophthalmia 29 . Sympathetic ophthalmia is a bilateral simultaneous granulomatous panuveitis due to the exposure of immune-privileged ocular antigens from an exciting eye following penetrating ocular trauma or surgery 30 . Activation of the immune response was once attributed to residual uveal tissue after evisceration 31,32 .…”

“…29 Sympathetic ophthalmia is a bilateral simultaneous granulomatous panuveitis due to the exposure of immune-privileged ocular antigens from an exciting eye following penetrating ocular trauma or surgery. 30 Activation of the immune response was once attributed to residual uveal tissue after evisceration. 31,32 However, sympathetic ophthalmia has been proven to be associated with genetic factors.…”