Sympathetic ophthalmia refers to bilateral granulomatous uveitis that occurs following a penetrating injury or intraocular surgery in one eye. The injured eye is referred to as the exciting eye, while the other eye is known as the sympathizing eye.
Etiology
The condition is primarily caused by exposure of intraocular antigens due to trauma or surgery, triggering an autoimmune response.
Clinical Manifestations
The onset typically occurs between 5 days and several weeks to months after the trauma or surgery, with most cases developing within 2 weeks to 2 months. The disease often begins insidiously and manifests as granulomatous inflammation. Fundus findings may resemble those seen in VKH disease, including a sunset glow fundus and Dalen-Fuchs nodules. Extraocular manifestations, such as vitiligo, hair whitening, alopecia, hearing loss, or symptoms of meningeal irritation, may also occur, although the incidence of these extraocular manifestations is relatively low.
Diagnosis
A history of penetrating ocular injury or intraocular surgery is crucial for diagnosing this condition and serves as an important distinction from VKH disease. Fundus fluorescein angiography (FFA) findings may show early multifocal leakage and late-phase dye pooling, often accompanied by optic disc staining.
Treatment
In cases involving anterior segment involvement, topical treatments such as corticosteroid eye drops and cycloplegic agents may be administered. For posterior or pan-uveitis, systemic corticosteroids or other immunosuppressive agents are generally used. Biological agents targeting tumor necrosis factor (TNF) may be considered if treatment outcomes are suboptimal, referencing approaches used in treating Vogt–Koyanagi–Harada (VKH) disease.
Prevention
Timely repair of the wound after a penetrating ocular injury and measures to avoid uveal prolapse and prevent infection may contribute to reducing the risk. There remains debate over whether enucleation of the injured eye can prevent the condition. Efforts should focus on preserving both vision and the structure of the injured eye as much as possible. In cases of irreparable globe rupture, enucleation may be considered.