Sympathetic Ophthalmia

Sympathetic ophthalmia is a rare, bilateral granulomatous panuveitis following accidental or surgical trauma to one eye. The pathophysiology is not clearly understood, but is believed to be a T-cell mediated autoimmune response. Clinical presentation most often occurs within the first year after trauma; anteriorly it manifests as a chronic or acute uveitis with mutton-fat keratic precipitates, while posteriorly it is often accompanied by yellowish-white choroidal lesions or Dalen-Fuchs nodules. The mainstay of treatment consists of systemic anti-inflammatory agents such as oral corticosteroids, or other immunosuppressive agents. Newer treatments include intravitreal injections of steroids in combination with systemic therapy, periocular injections of steroids without systemic therapy, and injections of infliximab, an anti-vascular endothelial growth factor.