What is Sympathetic ophthalmia (SO)

Sympathetic ophthalmia (SO) is a bilateral diffuse granulomatous uveitis (a kind of inflammation) of both eyes following trauma to one eye. It can leave the patient completely blind. Symptoms may develop from days to several years after a penetrating eye injury. Sympathetic ophthalmia is rare, affecting 0.2% to 0.5% of non-surgical eye wounds, and less than 0.01% of surgical penetrating eye wounds. There are no gender or racial differences in incidence of SO. Eye floaters and loss of accommodation are among the earliest symptoms. Once SO is developed, Immunosuppressive therapy is the mainstay of treatment. When initiated promptly following injury, it is effective in controlling the inflammation and improving the prognosis. Mild cases may be treated with local application of corticosteroids and pupillary dilators.

Sympathetic ophthalmia is a rare and potentially visually devastating bilateral panuveitis, typically following surgery or non-surgical penetrating injury to one eye. High index of suspicion is vital to ensure early diagnosis and initiation of treatment, thereby allowing good final visual acuity in most patients. Diverse clinical presentations are possible in SO and any bilateral uveitis following vitreoretinal surgery should alert the surgeon to the possibility of SO.

Although there is no consensus regarding optimal treatment, most experts concur that SO requires prompt attention and treatment. Prompt and effective management with systemic immunosuppressive agents may allow control the disease and retention of good visual acuity in the remaining eye. Modern immunosuppressive therapy with systemic steroids and steroid-sparing agents such as cyclosporin A and azathioprine have improved the prognosis of SO. However, informed consent for vitreoretinal surgery (especially in re-operations) should now include the risk of SO (approximately 1 in 800).

Arevalo, J Fernando et al. “Update on sympathetic ophthalmia.” Middle East African journal of ophthalmology vol. 19,1 (2012): 13-21. doi:10.4103/0974-9233.92111