Sympathetic ophthalmia: an immunohistochemistry study of four cases

We present histological and immunohistochemical data on four cases of sympathetic ophthalmia, a disease that is believed to occur predominantly after perforating injury to the eye. Only a few cases without previous perforation have been reported. Nevertheless, sympathetic ophthalmia should be taken into consideration if there is a bilateral intraocular inflammation, even without trauma, as in two of our cases (cases 1 and 2). An unusual case after uneventful intracapsular cataract extraction and a posttraumatic "classic" case are also presented (cases 3 and 4). We found a granulomatous infiltration of the uveal tract by lymphocytes, plasma cells, and epithelioid cells, particularly of the choroid. Dalen-Fuchs nodules were found in all cases, the second case also being associated with phacoanaphylaxis. Case 1 and 4 showed immunohistochemically a predominance of CD3-positive cells (T-lymphocytes), whereas in cases 2 and 3, many cells surprisingly stained positively for L26 (B-lymphocytes). In case 2 the immune response may have been altered by the additional phacoanaphylaxis. In all four cases, scattered epithelioid cells stained positively for CD 68. We conclude that in cases of bilateral uveitis, even without previous penetrating injury or after common intraocular surgery, sympathetic ophthalmia as a possible cause should be taken into consideration because an early diagnosis with subsequent enucleation of the exciting eye is of decisive influence on the course of the disease.