Sympathetic Ophthalmia as a Complication of Untreated Choroidal Melanoma

We present a rare case of sympathetic ophthalmia in the fellow eye of a 59-year-old Caucasian male diagnosed with untreated malignant choroidal melanoma. Initially identified with a medium-sized choroidal melanoma, the patient declined recommended brachytherapy and did not seek medical attention for two years. Upon returning, he exhibited signs of sympathetic ophthalmia in the contralateral eye. Treatment with corticosteroid-based immunosuppression was initiated. After consenting to treatment for the melanoma, the affected left eye was enucleated, and histopathology confirmed spindle cell choroidal melanoma. This case underscores the uncommon development of sympathetic ophthalmia without prior ocular trauma or surgery, linked to untreated choroidal melanoma.