Sympathetic uveitis (or ophthalmia) is a bilateral uveitis that develops following a penetrating injury or surgery involving one eye, resulting in the loss of vision in the second eye. It is a chronic, lymphocytic and granulomatous inflammatory process that is presumed to represent an autoimmune reaction.


Terms: The injured eye is called the "exciting" eye, while the secondarily affected eye is the "sympathizing" eye.


Frequency: rare


Precipitating events:

(1) penetrating injuries, especially those causing trauma to the ciliary body (these may be inapparent at the time of the injury)

(2) cataract extraction

(3) iris surgery

(4) retinal detachment repair

(5) vitreoretinal surgery


Onset: Anytime from 5 days to many years after the injury, most often from 2 - 8 weeks after the injury


Symptoms at onset - often the presentation is insidious:

(1) change in accomodative amplitude

(2) photophobia

(3) epiphora (overflow of tears down the cheek)


Ophthalmologic findings:

(1) low-grade, bilateral, anterior and posterior panuveitis with small precipitates

(2) Dalen-Fuchs nodules (small yellowish-white chorioretinal lesions)

(3) thickening of the iris with/without nodular deposits

(4) papillitis

(5) choroidal infiltration and thickening (thickening may be seen on ultrasound)

(6) retinal vascular sheathing

(7) disk edema

(8) fluorescein angiography may show (a) multiple, persistent foci of leakage, forming hyperfluorescent dots that may coalesce or (b) hypofluorescent foci that stain late


Systemic findings may occur infrequently:

(1) alopecia

(2) poliosis (premature graying)

(3) vitiligo

(4) headache

(5) dysacousis (impaired hearing) and tinnitus

(6) meningeal irritation


Complications, especially if inadequately treated:

(1) cataract

(2) band keratopathy

(3) secondary glaucoms

(4) retinal detachment

(5) choroidal scarring

(6) macular edema and scarring

(7) optic atrophy

(8) hypotony

(9) blindness

(10) phthisis bulbi


Prevention: Enucleation of an irreversibly injured eye within 2 weeks of injury and prior to onset of symptoms can prevent most (but not all) cases.


Therapy: Early and aggressive therapy with corticosteroids with/without immunosuppression (cyclosporin or azathioprine).


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