[Emergency] ATLAS OF SYMPATHETIC OPHTHALMIA

OPHTHALMIC CONDITIONS, The Atlas of Emergency Medicine, Fourth Edition, 2016.ATLAS OF SYMPATHETIC OPHTHALMIA, SYMPATHETIC OPHTHALMIA

SYMPATHETIC OPHTHALMIA 

Clinical Summary

This rare disorder presents as an insidious or acute anterior uveitis of both eyes (exciting and sympathizing eye) after recent or remote trauma to the exciting eye. The initial injury is usually from prior penetrating eye trauma with delayed wound closure or, less commonly, from prior eye surgery.

The disease is thought to be an autoimmune inflammatory response against choroidal melanocytes released due to trauma. It may develop rapidly or insidiously, presenting from days to years after the inciting traumatic event. Most cases develop within 1 year.

Earliest symptoms include eye floaters and loss of accommodation. The disease may progress to severe uveitis with redness, pain, and photophobia in the sympathizing, noninjured eye.

Classically, there is a granulomatous anterior chamber reaction with mutton-fat keratic precipitates seen on the corneal endothelium. 

FIGURE 2.39 ■ Sympathetic Ophthalmia. This patient with prior ocular 

trauma (untreated globe rupture) OS presented with pain and

redness OD, thought to be due to sympathetic ophthalmia. OS enucleation 

and treatment with steroids resolved condition.

Management and Disposition

Diagnosis is suspected clinically. Consider other causes of granulomatous uveitis such as sarcoidosis, tuberculosis, and syphilis. Consult ophthalmology for management, which may include topical steroids, evisceration, or enucleation of the eye with prior trauma.

Pearls

1. Consider sympathetic ophthalmia with unexplained uveitis and a history of penetrating eye trauma.

2. Solicit a history of eye trauma or prior eye surgery when evaluating eye pain, blurred vision, and redness.

3. Early intervention can be sight saving. 

REFERENCES
The Atlas of Emergency Medicine, Fourth Edition, 2016.