Ophthalmica Sympathica.
Specific bilateral inflammation of the uveal tract due to chronic irritation of one eye, caused by a perforating wound to the eye or intraocular surgery, produces transferred uveitis in the fellow eye.
Epidemiology – Sympathetic ophthalmia is very rare.
Etiology - Sympathetic uveitis can occur in an otherwise unaffected eye even years after penetrating injuries or intraocular surgery in the fellow eye, especially where there was chronic irritation. Tissues in the injured eye (uveal tract, lens, and retina) act as antigens and provoke an autoimmune disorder in the unaffected eye.
Symptoms - The earliest symptoms include limited range of accommodation and photophobia. Later there is diminished visual acuity and pain. There is usually no pain when this condition first sets in, but the individual suffering from the disease will begin to experience blurred vision as the eye loses its ability to focus properly. Eventually the symptoms progress to include:
- Severe eye pain and redness in both eyes
- Extreme sensitivity to light (a condition known as photophobia)
- “Floaters” in the visual field
- Watery eyes
- Visual impairment, eventually leading to blindness
Under a slit-lamp examination, an examining doctor may see clumps of inflammatory cells on the posterior corneal surface. These are called “mutton-fat” keratic precipitates. Other signs visible to an eye care specialist include swelling, a thickening of the uvea, and whitish lesions within the choroid (the layer of tissue between the retina and the sclera - see our breakdown of eye anatomy). While there is no test that can detect the presence of SO with absolute certainty, these signs, combined with a medical history that includes the right kind of injury to the other eye, can give a doctor good reason to suspect sympathetic ophthalmia.
Diagnostic considerations - Clinical symptoms include combined injections, cells and protein in the anterior chamber and vitreous body, papillary and retinal edema, and granulomatous inflammation of the choroid.
Treatment - The injured eye, which is usually blind, must be enucleated to eliminate the antigen. High-dose topical and systemic steroid therapy is indicated. Concurrent treatment with immunosuppressives (cyclophosphamide and azathioprine) may be necessary.