Sympathetic Ophthalmia

Sympathetic Ophthalmia with Dalen Fuchs nodules or hypopigmented lesions © 2019 American Academy of Ophthalmology

Sympathetic Ophthalmia



Sympathetic Ophthalmia is a rare granulomatous panuveitis that occurs in both eyes after penetrating injury to the eye. This injury usually associated with uvea prolapsed. Sometimes it can occur after intraocular surgery in which there is extensive manipulation of the uvea tract which will be recognized as foreign body.

There will be autoimmune reaction against melanocytes-containing tissues of the eye such as retinal pigment epithelial layer, choroid, Ciliary body and iris. This autoimmune reaction will cause inflammation of these tissues with infiltration of inflammatory cells.

It affects both eyes and usually occurs between 2 weeks to 3 months after the trauma but it can extend to 1 year. The traumatized eye is called the exciting eye while the normal or fellow eye is called sympathizing eye.



Sign and Symptoms of Sympathetic Ophthalmia

1- The earliest symptom is loss or decrease in accommodation because of the involvement of the Ciliary body.

2- The earliest sign is inflammatory cells seen in the vitreous, behind the lens.

3- Floaters and photophobia in the normal or sympathizing eye.

4- Inflammatory cells that can be seen in the anterior chamber and also in the posterior segment of the eye (panuveitis).

5- Ocular pain.

6- Dalen Fuchs nodules are inflammatory cells between the retinal pigment epithelial layer and the choroid.

7- Because the inflammation involves the choroid, there will be multiple areas of choroiditis which with time can cause collection of exudates or fluid under the retina, leading to exudative retinal detachment. Exudative retinal detachment is associated with decrease in vision.

8- Inflammation near the optic disc can cause optic disc swelling.

9- Chronic form is characterized by chorioretinal scarring and atrophy of retinal pigment epithelial.



Prevention of Sympathetic Ophthalmia

A decision should be made within the first 10 days after injury to enucleate the exciting eye which will help to prevent the formation of autoimmune reaction against Melanocytes-containing tissues.

The enucleation should be done only to eyes with hopeless visual prognosis because sometimes patients with Sympathetic Ophthalmia, the exciting eye can have better visual prognosis than the sympathizing eye.


Treatment of Sympathetic Ophthalmia

Once the disease has developed, enucleation of the exciting eye will not prevent the inflammation in the Sympathizing eye.

Topical: corticosteroid eye drops and pupil dilators. Decrease inflammation, formation of synechia and ocular pain.

Systemic medications: Steroid and/or immunosuppressive medications such as ciclosporin and azathioprine.

This disease may require long term treatment and follow-up visits because recurrent episodes after cessation of treatments can occur.



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