Abstract
Background Sympathetic ophthalmia (SO) is a rare inflammation of an operated or injured eye
that spreads to the fellow eye. It is typically a bilateral granulomatous panuveitis.
The traumatized eye is referred to as inciting eye and the fellow eye as sympathizing
eye. The pathophysiology of the disease is not entirely understood, but there is strong
evidence of an autoimmune genesis.
Patients/Material and Methods A selective literature search on epidemiology, immunology, clinical features and
risk factors of SO was carried out. In addition, our own experience using multimodal
imaging for this clinical entity was introduced.
Results In the literature, the incidence after traumatic eye injuries is 0.1 – 3% and approximately
0.01% after intraocular surgery. Among the iatrogenic causes, vitreoretinal surgery
has the highest rate of SO, presumably due to disruption of the blood-retinal barrier
and involvement of retinal and choroidal tissue, which are susceptible to anterior
traction, phthisis and chronic inflammation. In 90% of patients, the disease develops
within a year following the eliciting event and is associated with a potentially bilateral
risk of blindness. Typical symptoms include bilateral visual impairment with photophobia,
dull pain and photopsia. The spectrum of clinical manifestations ranges from granulomatous
anterior uveitis and vitritis, to choroiditis, serous retinal detachment and Dalen-Fuchs
nodules in the context of posterior involvement. The diagnosis of SO is generally
based on clinical presentation and is supported by imaging methods. These primarily
comprise
fluorescein and indocyanine green angiography, which are increasingly being supplemented
by non-invasive methods such as optical coherence tomography. They can provide important
information for assessment of severity, differential diagnosis as well as for disease
monitoring. The differential diagnosis includes i. a. Vogt-Koyanagi-Harada syndrome,
ocular sarcoidosis and the rare phacoanaphylactic endophthalmitis. Immediate systemic
high-dose steroid therapy is used as initial treatment. The course of the disease
is often relapsing to chronic progressive. Immunomodulators such as ciclosporine A,
azathioprine, cyclophosphamide, mycophenolate mofetil, and biologics are increasingly
being used and contribute to the significantly better prognosis of the disease. Generally,
SO can be triggered by any kind of intraocular intervention.
Conclusion SO remains a threatening clinical diagnosis that poses diagnostic and therapeutic
challenges. It can be triggered post-traumatic, but also any intraocular surgery.
This should be taken into account when assessing the indication for intraocular eye
surgery, especially in eyes with reduced visual outcome.
Key words
autoimmune disease - Dalen-Fuchs nodules - granulomatous uveitis - intraocular Inflammation
- sympathetic ophthalmia
