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Sympathetic Ophthalmia

By Emmett T. Cunningham, Jr., MD, PhD, MPH, Stanford University;The Uveitis Service, California Pacific Medical Center and Clinic

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Sympathetic ophthalmia is inflammation of the uveal tract after trauma or surgery to the other eye.

Sympathetic ophthalmia is a rare granulomatous uveitis that occurs after penetrating trauma or surgery to the other eye. Sympathetic ophthalmia has been estimated to occur in up to 0.5% of nonsurgical penetrating eye wounds and in about 0.03% of surgical penetrating eye wounds. The underlying mechanism is thought to be an autoimmune reaction directed against melanin-containing cells in the uvea. Uveitis appears within 2 to 12 wk after trauma or surgery in about 80% of cases. Isolated cases of sympathetic ophthalmia have occurred as early as 1 wk or as late as 30 yr after the initial trauma or surgery.

Symptoms typically include floaters and decreased vision. Choroiditis, often with overlying exudative retinal detachment, is common.

Diagnosis is clinical.

Treatment

  • Oral corticosteroids and immunosuppressants

  • With severe injuries, possibly early prophylactic enucleation

Treatment typically requires oral corticosteroids (eg, prednisone, 1 mg/kg po once/day) followed by long-term use of a noncorticosteroid immunosuppressive drug. Prophylactic enucleation of a severely injured eye should be considered within 2 wk of vision loss to minimize the risk of sympathetic ophthalmia developing in the other eye, but only when the injured eye has no vision potential.

* This is the Professional Version. *