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Sympathetic ophthalmia associated with cyclitis: case report.

Y H Kuo¹, C J Juang

¹Department of Ophthalmology, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C.

Changgeng Yi Xue Za Zhi

|September 24, 1999

Summary

A penetrating eye injury led to sympathetic ophthalmia in the other eye. Prompt treatment with corticosteroids and cyclosporine improved vision and resolved retinal detachment.

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Area of Science:

Ophthalmology
Immunology

Background:

Sympathetic ophthalmia is a rare, bilateral granulomatous inflammation following ocular trauma or surgery.
Delayed diagnosis can lead to severe vision loss due to progressive intraocular inflammation.

Observation:

A 41-year-old male presented with photophobia and redness in the left eye six weeks after a penetrating injury to the right eye.
Initial presentation mimicked narrow-angle glaucoma, but subsequent vision loss and fundus findings revealed sympathetic ophthalmia.
Ocular findings included decreased visual acuity, shallow anterior chamber, elevated intraocular pressure, annular serous retinal detachment, and Dalen-Fuchs nodules.

Findings:

High-dose intravenous corticosteroids (methylprednisolone) and subtenon dexamethasone initiated treatment, improving vision to 0.1.
Combination therapy with oral prednisolone and cyclosporine (serum level 118 ng/ml) led to further vision improvement to 0.6 and resolution of retinal detachment within three months.
Renal function and hematocrit remained stable throughout treatment.

Implications:

Early recognition and aggressive immunosuppressive therapy are crucial for managing sympathetic ophthalmia.
Combination therapy with corticosteroids and cyclosporine can be effective in restoring vision and preventing further damage.
This case highlights the importance of considering sympathetic ophthalmia in patients with a history of ocular trauma presenting with contralateral uveitis.

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