Sympathetic ophthalmia, a rare condition that occurs after a penetrating ocular injury or ocular surgery, is caused by exposure of the immune system to sequestered uveal antigens. Its ocular findings are clinically and histologically indistinguishable from those in VKH disease. Inflammation of the exciting (injured or operated) and sympathizing (fellow) eye may occur days to decades after the initial insult. As in VKH disease, the inflammation is bilateral and is characterized by the presence of panuveitis, often associated with areas of serous retinal detachment and focal choroiditis (nummular chorioretinal lesions). Nonocular complications, such as vitiligo or poliosis, can occur but are much less common than in VKH disease. Moreover, in the rare instances when sympathetic ophthalmia does follow either injury or surgery, standard treatments almost always control the inflammation. Therefore, enucleation or evisceration of an injured eye to minimize risk of sympathetic ophthalmia should be undertaken only when the eye is painful, structurally disorganized, and has no light perception. Optimally, the enucleation should occur within 14 days of the trauma; it is thought immune activation against otherwise sequestered antigens in the eye does not occur until later. However, this 14-day timeline is becoming increasingly controversial.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.