Introduction
Rare bilateral diffuse granulomatous intraocular inflammation that occurs in most cases within days or months after surgery or penetrating trauma to one eye.
- Injured eye referred to as exciting eye, while fellow non-injured eye is called sympathizing eye
History:
The condition was first recognized by Hippocrates, but was first described and named by William Mackenzie in the 1840. Fuch’s provided the first histopathologic details in 1905. He established it as a separate disease entity, distinct from other ocular inflammatory disorders. Fuchs and Dalen independently described the inflammatory nodular aggregates termed “Dalen-Fuchs nodules“.
Clinical features
Sympathizing (non-injured eye):
Classically presents as a bilateral diffuse uveitis
- Insidious onset of blurry vision, pain, epiphora, and photophobia
- Classically accompanied by:
- Conjunctival injection
- Granulomatous anterior chamber reaction with mutton-fat keratic precipitates (KPs) on the corneal endothelium
Diagnosis
Fundus examination:
- Dalen Fuchs nodules (local granulomas due to proliferation of lymphocytes and epitheloid cells) located b/t RPE & Bruch’s membrane
Differential diagnosis:
- Vogt-Koyanagi-Harada disease (VKHD)
Management
Systemic corticosteroids:
First-line therapy
- Topical/sub-tenon or transseptal injection/systemic administration
Long-term immunomodulatory therapy
Refractory/severe cases
- Cyclosporine, azathioprine or other immunosuppressive agents