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. This is the same mechanism suspected in Vogt-Koyanagi-Harada disease. Uveitis appears within 2 to 12 weeks after trauma or surgery in about 80% of cases. Isolated cases of sympathetic ophthalmia have occurred as early as 1 week or as late as 30 years after the initial trauma or surgery.
Symptoms of the granulomatous uveitis can involve any or all segments of the eye. Symptoms typically include floaters and decreased vision. Serous detachments and choroiditis are common.
Diagnosis is clinical.
(See also Overview of Uveitis.)
Treatment typically requires oral corticosteroids (eg, prednisone, 1 mg/kg orally once/day) followed by long-term use of a noncorticosteroid immunosuppressive drug. Prophylactic enucleation of a severely injured eye should be considered within 2 weeks 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.