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Sympathetic Ophthalmia

By Kara C. LaMattina, MD, Assistant Professor of Ophthalmology, Boston University School of Medicine

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Sympathetic ophthalmia is inflammation of the uveal tract (uveitis) that occurs in one eye after injury or surgery to the other eye.

Sympathetic ophthalmia is a rare type of uveitis that causes small abnormal clumps of cells (granulomas) to form. This disorder occurs in the uninjured eye after a penetrating injury (such as when a pencil, pen, or stick punctures the eye) or surgery to the other (injured) eye. Eventually, the uveal tract in the uninjured eye becomes inflamed. Although the cause of sympathetic ophthalmia is not completely known, many doctors think it is due to a malfunction of the body's immune system that causes the body to attack the uninjured uvea. Uveitis appears within 2 to 12 weeks after injury or surgery in about 80% of affected people. Very rarely, sympathetic ophthalmia occurs as early as 1 week or as late as 30 years after the initial injury or surgery.

A View of the Uvea

Symptoms

Symptoms of sympathetic opthalmia typically include floaters and decreased vision.

Diagnosis

  • A doctor's evaluation

Doctors base the diagnosis of sympathetic opthalmia on an eye examination and whether the person has had a recent eye injury or surgery and whether there is inflammation in both eyes.

Treatment

  • Corticosteroids and immunosuppressants

  • Sometimes removal of eye

Treatment of sympathetic ophthalmia typically requires corticosteroids taken by mouth plus another type of drug that suppresses the immune system (immunosuppressant) and is taken long term.

Sometimes doctors remove a severely injured eye within 2 weeks of vision loss to minimize the risk of sympathetic ophthalmia developing in the uninjured eye. However, the removal procedure is done only when there is complete loss of vision in the injured eye and there is no chance that vision will be recovered.

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