Sympathetic ophthalmia is inflammation of the uveal tract after trauma or surgery to the other eye.
(See also Overview of Uveitis)
Sympathetic ophthalmia is a rare granulomatous uveitis that occurs after penetrating trauma or surgery to the other eye. Sympathetic ophthalmia has been estimated to occur in up to 0.5% of nonsurgical penetrating eye wounds and in about 0.03% of surgical penetrating eye wounds. The underlying mechanism is thought to be an autoimmune reaction directed against melanin-containing cells in the uvea. Uveitis appears within 2 to 12 wk after trauma or surgery in about 80% of cases. Isolated cases of sympathetic ophthalmia have occurred as early as 1 wk or as late as 30 yr after the initial trauma or surgery.
Symptoms typically include floaters and decreased vision. Choroiditis is common.
Diagnosis is clinical.
Treatment typically requires oral corticosteroids (eg, prednisone, 1 mg/kg po once/day) followed by long-term use of a noncorticosteroid immunosuppressive drug. Prophylactic enucleation of a severely injured eye should be considered within 2 wk of vision loss to minimize the risk of sympathetic ophthalmia developing in the other eye, but only when the injured eye has no vision potential.