Makindo Medical Notes.com

Famously happened to Louis Braille (the inventor of braille writing) after an injury to one eye

About

• An autoimmune, type 4 hypersensitivity reaction
• Following penetrating trauma or surgery to one eye
• Patients may develop autoimmune inflammation of the fellow eye.

Aetiology

• A rare granulomatous inflammatory reaction to melanin containing structures such as the photoreceptor outer segments
• Develops after penetrating trauma or surgery to the fellow eye

Clinical

• A history of eye trauma. Patients present with a florid pan-uveitis in the fellow eye
• Usually occurs approximately three months after initial injury, but may be many years later
• Significant reduction in vision, pain, photophobia, conjunctival injection
• Mutton fat keratitic precipitates
• Dalen-fuchs nodules – clusters of epithelioid cells between the RPE and Bruch’s membrane

Investigations

• A clinical diagnosis based on a history of ocular trauma and the clinical findings listed above
• OCT scan can be helpful in assessing any retinal complications such as retinal detachment or macular oedema
• Fluorescein angiography may be helpful

Management

• In the acute phase, high dose IV methylprednisolone should be initiated immediately
• Immunosuppression with agents such as azathioprine, ciclosporin, or cyclophosphamide
• Enucleation may be considered for a painful, non-seeing eye

Prognosis

• Vision loss can be severe and complete loss of sight is common
• In the majority of cases, prompt treatment with steroids and systemic immunosuppression can help preserve some degree of visual acuity

References

• Sympathetic ophthalmia. Francisco Max Damico, Szilárd Kiss, Lucy H Young
• Sympathetic Ophthalmitis - A miraculous tragedy