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Ocular System

Sympathetic ophthalmia (SO)

Rare bilateral diffuse granulomatous intraocular inflammation that occurs in most cases within days or months after surgery or penetrating trauma to one eye.

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
Acute anterior uveitis with keratic precipitates, posterior synechiae and fibrin on the anterior lens capsule in the right eye of a 25-year-old male, who had sustained a penetrating trauma to his left eye 3 months earlier | BenErza D. sympathetic ophthalmia. In: BenErza, editor. Ocular Inflammation, Basic and Clinical Concepts. Martin Dunitz Ltd: London; 1999. pp. 377–92.

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

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