Sympathetic Ophthalmia

Definition: Bilateral granulomatous panuveitis that occurs after surgery or penetrating injury to the other eye.

90% develop within 1 year.

Incidence of 0.2% after trauma & 0.01% after surgery.

Early treatment – 50% achieved 6/12 VA.

Late complications – secondary glaucoma, chronic maculopathy, phthisis bulbi.

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Presentation:

1. Bilateral AAU with mutton fat KPs (classical)

2. Dalen-Fuchs nodules – white-yellowish lesions at RPE

3. Exudative RD / ONH oedema / CNV / vasculitis / choroiditis / vitritis / CMO

Management:

1. Good history and clinical examination.

2. Investigative tools – FFA, ICG, OCT, USS

3. High dose steroids (up to 2mg/kg/day) with gradual tailoring up to 3 months or pulse methylprednisolone (1g/day) for 3 days.

4. Immunosuppressive therapy – cyclosporine, cyclophosphamide, azathioprine, chlorambucil.

5. Intravitreal therapy – IVTA

6. Prophylactic evisceration/enucleation of injured eye within 10 days.

Special note: With current surgical trend (especially VR surgery), any clinical uveitis in fellow eye – to consider this disease.

Differentials:

1. Vogt-Koyanagi-Harada disease – usually Asian/blacks, no penetrating injury, with common skin and CNS changes and exudative RD and pleoyctosis in CSF.

2. Sarcoidosis

3. Syphilis