Update on sympathetic Ophthalmia

Abstract

Sympathetic ophthalmia (SO) is a bilateral diffuse granulomatous intraocular inflammation that occurs in most cases within days or months after surgery or penetrating trauma to one eye. The incidence of SO ranges from 0.2 to 0.5% after penetrating ocular injuries and 0.01% after intraocular surgery. Vitreoretinal surgery and cyclodestructive procedures are considered risk factors. The time from ocular injury to onset of SO varies greatly, ranging from a few days to decades, with 80% of the cases occurring within 3 months after injury to the exciting eye and 90% within 1 year. The diagnosis is based on clinical findings rather than on serological testing or pathological studies. It presents as a bilateral diffuse uveitis. Patients report an insidious onset of blurry vision, pain, epiphora, and photophobia in the sympathizing, non-injured eye. Classically this is accompanied by conjunctival injection and a granulomatous anterior chamber reaction with mutton-fat keratic precipitates (KPs) on the corneal endothelium. In the posterior segment, the extent of inflammation can vary. Systemic corticosteroids are the first line therapy for SO. If patients are non-responsive to steroid therapy or have clinically significant side effects, cyclosporine, azathioprine or other immunosuppressive agents can be used for long-term immunomodulatory therapy.

A case of Vogt-Koyanagi-Harada disease mimicking sympathetic ophthalmia

“…The retina is characterized by sub-retinal pigment epithelium yellow-white nodular lesions (corresponding to the histopathologic Dalen-Fuchs nodules). Dalen-Fuchs nodules are not pathognomonic of SO and were seen in only 1/3 of enucleations in one study [3]. At times, the anterior chamber reaction is relatively mild and non-granulomatous.…”

“…Thus, preservation of both eyes should be attempted if possible. The sympathizing eye may develop sequelae of SO such as: secondary glaucoma, cataract, retinal or optic atrophy, retinal detachment, sub-retinal fibrosis, choroidal atrophy, choroidal neovascularisation and phthisis bulbi [3].…”

“…In our patient, the injury had occurred to the right eye nearly 20 years ago. SO is a serious public health problem as it can lead to blindness in both eyes [2][3][4].…”

Sympathetic Ophthalmia

“…These days ocular surgery particularly vitreoretinal surgery has emerged as major risk for the development of SO. Non-perforating ocular procedures like irradiation and laser therapies have also been associated with SO [13]. Improved access to emergency surgical care following penetrating ocular traumas and improved microsurgical techniques have undoubtedly influenced this etiologic shifts from penetrating injuries to surgical traumas [5].…”

Sympathische Ophthalmie

“…In 90 % der Fälle tritt dies innerhalb des ersten Jahres nach dem auslösendem Trauma auf, allerdings sind auch Fälle mit einem zeitlichen Abstand von mehreren Jahrzehnten veröffentlicht worden [1,4]. Es kommt zu einer beidseitigen granulomatösen Panuveitis.…”