SYMPATHETIC OPHTHALMIA


DESCRIPTION: A rare, bilateral granulomatous uveitis, associated with either a perforating eye injury in the region of the ciliary body or a retained foreign body in the eye. The exact cause is unknown, but it is believed to be related to sensitivity (i.e., a reaction) to uveal pigment. It has been known to follow uncomplicated intraocular surgery for cataracts or glaucoma. The injured eye becomes inflamed first, and the other eye follows (i.e., "sympathetically"). Symptoms include photophobia, redness, and blurred vision; in some cases, there are also "floaters" and possibly pain. The history of trauma differentiates this condition from other types of granulomatous uveitis; other differentiating factors include its bilateral, diffuse, and acute nature.

(see also Wounds)

TREATMENT: A severely injured eye with poor prognosis for visual functioning should be enucleated to prevent sympathetic ophthalmia. If this is done within 10 days following the injury, the chances are almost nil of later sympathetic ophthalmia in the good eye. If, however, inflammation in the sympathizing eye is relatively advanced, enucleation of the injured eye is not recommended; visual function is likely to be severely impaired in both eyes, but the injured eye may turn out to be the better of the two eyes, since optic nerve damage (due to papilledema) and secondary glaucoma may occur in the sympathetic eve.

Local cortlcosteroids and atropine (and possibly systemic cortlcosteroids) may be administered immediately if sympathetic inflammation has been diagnosed. Untreated, sympathetic ophthalmia can progress to complete bilateral blindness over a period of months or years.

IMPLICATIONS: If an eye report indicates severe trauma to an eye (notably a puncture wound or a retained foreign object), sympathetic ophthalmia is a threat. Since it may occur 10 days to many years following the injury, the individual should seek medical attention immediately at the first sign of blurred vision, redness, or photophobia.


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