Sympathetic ophthalmia

Background

• Uveitis of both eyes, following trauma to one eye
  • Due to autoimmune inflammatory response after introduction of immune system to ocular antigens during trauma
  • Can develop within days to years of initial trauma
  • Affects 0.03 per 100,000 persons per year
• Prevention
  • Because it is so rare, enucleation often not done immediately, if chance of regaining function

Clinical Features

• Symptoms
  • Floaters
  • Loss of accommodation
  • Eye pain, photophobia

Differential Diagnosis

Acute onset flashers and floaters

• Ocular causes
  • Floaters and/or flashes
    • Posterior vitreous detachment
    • Retinal tear or retinal detachment
    • Posterior uveitis
  • Predominantly floaters
    • Vitreous hemorrhage secondary to proliferative retinopathy
    • Sympathetic ophthalmia
  • Predominantly flashes
    • Oculodigital stimulation
    • Rapid eye movements
    • Neovascular age-related macular degeneration
• Non-ocular causes
  • Intraocular foreign body
  • Migraine aura (classic)
  • Migraine aura (acephalgicmigraine)
  • Occipital lobe disorders
  • Postural hypotension

Management

• Immunosuppressive therapy
• Mild: topical steroids and pupillary dilators
• Severe: Systemic steroids, chlorambucil, cyclophosphamide
• Enucleation can reduce symptoms even after the condition has developed

References

• Rosen's Emergency Medicine
• Sympathetic Ophthalmia: https://en.wikipedia.org/wiki/Sympathetic_ophthalmia. Updated on 17 September 2014.