Sympathetic ophthalmia is a rare, severe inflammatory condition affecting both eyes. It typically develops after a penetrating injury or surgical procedure to one eye. This disorder involves an immune response that mistakenly targets healthy eye tissue in both the initially injured eye and the previously unaffected eye.
Causes and Development
The condition begins following a penetrating injury to one eye, such as trauma or intraocular surgery. The eye that sustains the initial injury is referred to as the “exciting eye,” while the uninjured eye that subsequently develops inflammation is known as the “sympathizing eye.” The underlying mechanism is believed to be an autoimmune response.
During the initial injury or surgery, previously hidden eye proteins are exposed to the body’s immune system. The immune system, which normally does not encounter these specific proteins, identifies them as foreign invaders and mounts an attack. This immune reaction then mistakenly targets similar healthy tissues in both the injured eye and the uninjured eye, leading to widespread inflammation of the uveal tract. The onset of this inflammation can vary widely, typically appearing within 2 to 12 weeks after the initial injury or surgery, though it can occur as early as one week or as late as 30 to 50 years later.
Recognizing the Symptoms
Patients experiencing sympathetic ophthalmia often notice a range of symptoms that can affect both eyes. Common manifestations include blurred vision, the appearance of floating spots in their visual field, and discomfort or pain in the eyes. Increased sensitivity to light, known as photophobia, and noticeable redness of the eyes are also frequently reported. These symptoms developing in the previously healthy eye are a strong indicator of the condition.
The inflammation can extend throughout the uveal tract, affecting the iris, ciliary body, and choroid. Patients might also experience a loss of near vision due to inflammation affecting the ciliary body’s ability to focus.
How Sympathetic Ophthalmia is Diagnosed
Diagnosing sympathetic ophthalmia primarily relies on clinical assessment, as there is no single blood test that definitively confirms the condition. A detailed medical history, specifically noting any prior penetrating eye injury or intraocular surgery, is important.
An ophthalmologist conducts a thorough eye examination of both eyes, looking for characteristic signs of inflammation. The presence of inflammation in both eyes following a relevant history strongly suggests sympathetic ophthalmia. Imaging tests can further support the diagnosis and help assess the extent of inflammation within the eye. These supportive tests may include fluorescein angiography, which visualizes blood flow and leakage, or optical coherence tomography (OCT), which provides detailed cross-sectional images of the retina.
Treatment and Prevention Strategies
Treatment for sympathetic ophthalmia focuses on controlling the inflammation to preserve vision. The primary approach involves the use of high-dose corticosteroids, which can be administered orally or intravenously. These medications suppress the body’s immune response and reduce inflammation. Initial high doses are typically tapered down over time as the inflammation subsides.
For long-term management and to minimize the side effects associated with prolonged corticosteroid use, immunomodulatory or immunosuppressive drugs are often introduced. These medications help to regulate the immune system over an extended period, preventing recurrence of inflammation and allowing for a reduction in steroid dosage.
In some instances, prevention of sympathetic ophthalmia can be considered. If an injured eye has no chance of recovering vision and is causing pain, surgical removal of the eyeball, known as enucleation, may be recommended. This procedure is typically performed promptly after the injury, ideally within 7 to 14 days, to prevent the autoimmune response from developing in the uninjured eye.
Visual Prognosis and Long-Term Outlook
The visual prognosis for individuals with sympathetic ophthalmia has improved. Many patients are now able to retain useful vision, with studies indicating that 70% to 80% of patients maintain driving-level vision in the sympathizing eye. The outcome for each individual largely depends on how severe the inflammation is at the time of diagnosis and how effectively the patient responds to the initial and ongoing treatment.
Despite improved outcomes, sympathetic ophthalmia can be a relapsing condition, meaning inflammation may recur even years after initial treatment. Therefore, long-term, regular follow-up appointments with an ophthalmologist are necessary. This consistent monitoring allows for early detection of any flare-ups and prompt adjustment of management strategies, which is important for maintaining visual function over time.