Sympathetic ophthalmia is inflammation of the uveal tract after trauma or surgery to the other eye.

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, often with overlying exudative retinal detachment, 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.

Last full review/revision September 2012 by Emmett T. Cunningham, Jr., MD, PhD, MPH