Sympathetic Ophthalmia

Sympathetic ophthalmia (SO) is a bilateral diffuse granulomatous uveitis (a kind of inflammation) of both eyes following trauma to one eye. It can leave the patient completely blind. Symptoms may develop from days to several years after a penetrating eye injury. Sympathetic ophthalmia is rare, affecting 0.2% to 0.5% of non-surgical eye wounds, and less than 0.01% of surgical penetrating eye wounds. There are no gender or racial differences in incidence of SO. Eye floaters and loss of accommodation are among the earliest symptoms. Once SO is developed, Immunosuppressive therapy is the mainstay of treatment. When initiated promptly following injury, it is effective in controlling the inflammation and improving the prognosis. Mild cases may be treated with local application of corticosteroids and pupillary dilators.

Sympathetic ophthalmia is a rare and potentially visually devastating bilateral panuveitis, typically following surgery or non-surgical penetrating injury to one eye. High index of suspicion is vital to ensure early diagnosis and initiation of treatment, thereby allowing good final visual acuity in most patients. Diverse clinical presentations are possible in SO and any bilateral uveitis following vitreoretinal surgery should alert the surgeon to the possibility of SO.

Although there is no consensus regarding optimal treatment, most experts concur that SO requires prompt attention and treatment. Prompt and effective management with systemic immunosuppressive agents may allow control the disease and retention of good visual acuity in the remaining eye. Modern immunosuppressive therapy with systemic steroids and steroid-sparing agents such as cyclosporin A and azathioprine have improved the prognosis of SO. However, informed consent for vitreoretinal surgery (especially in re-operations) should now include the risk of SO (approximately 1 in 800).[rx]

Sympathetic Ophthalmia (SO) is an eye disorder in which the immune system mistakenly attacks the healthy tissue of one eye (known as the “sympathizing eye”) due to an injury or inflammation in the other eye (known as the “exciting eye”).

Types of Sympathetic Ophthalmia

There are no specific types of SO, but it can be categorized based on its severity and progression:

  1. Acute Sympathetic Ophthalmia: Rapid onset of inflammation and symptoms.
  2. Chronic Sympathetic Ophthalmia: Slow, gradual progression of the condition.

 Causes of Sympathetic Ophthalmia

SO is typically triggered by eye injuries or surgeries. Here are some common causes:

  1. Eye injuries: Trauma to one eye can lead to inflammation, which may trigger an immune response in the other eye.
  2. Eye surgeries: Procedures like cataract surgery or retinal detachment repair can provoke SO.
  3. Foreign bodies: Penetrating objects or foreign materials entering the eye can incite inflammation.

Symptoms of Sympathetic Ophthalmia

Identifying the symptoms of SO is crucial for early intervention. Common signs include:

  1. Blurred vision: Vision becomes hazy or unclear.
  2. Eye pain: Aching or discomfort in the affected eye.
  3. Redness: The eye appears red or bloodshot.
  4. Sensitivity to light: Increased sensitivity to bright lights.
  5. Floaters: Seeing spots or tiny specks in the vision.
  6. Photophobia: Strong aversion to light.
  7. Watery eyes: Excessive tearing.
  8. Changes in color vision: Difficulty perceiving colors accurately.
  9. Decreased visual acuity: Loss of sharpness in vision.
  10. Visual field loss: Reduced peripheral vision.

Diagnostic Tests for Sympathetic Ophthalmia

Diagnosing SO involves a combination of clinical evaluations and specialized tests, such as:

  1. Eye examination: An ophthalmologist assesses the affected eye’s appearance, function, and symptoms.
  2. Visual acuity test: Measures how well you can see at various distances.
  3. Slit-lamp examination: A high-intensity light and microscope help examine the eye’s internal structures.
  4. Fundus photography: Captures detailed images of the retina.
  5. Optical coherence tomography (OCT): Provides cross-sectional images of the retina and optic nerve.
  6. Fluorescein angiography: Evaluates blood flow in the retina.
  7. Ultrasound: Uses sound waves to visualize eye structures.
  8. Blood tests: Detect antibodies that indicate an immune response.
  9. Biopsy (rare): Tissue sample analysis from the affected eye may be necessary in some cases.

Treating Sympathetic Ophthalmia

Treatment for SO aims to reduce inflammation and preserve vision. Common approaches include:

  1. Corticosteroids: Medications like prednisone help control inflammation.
  2. Immunosuppressive drugs: Azathioprine, cyclosporine, or mycophenolate mofetil may be prescribed to suppress the immune system’s response.
  3. Biologics: Drugs like infliximab can target specific immune pathways.
  4. Topical medications: Eye drops containing steroids or non-steroidal anti-inflammatory drugs (NSAIDs) reduce inflammation locally.
  5. Plasmapheresis: A procedure to remove antibodies from the blood.
  6. Surgery: In severe cases, surgical interventions like vitrectomy or retinal detachment repair may be necessary.

Drugs Used in Sympathetic Ophthalmia Treatment

  1. Prednisone: A common corticosteroid to control inflammation.
  2. Azathioprine: An immunosuppressant that helps modulate the immune response.
  3. Cyclosporine: Suppresses the immune system’s activity.
  4. Mycophenolate mofetil: Another immunosuppressive drug.
  5. Infliximab: A biologic agent that targets specific immune pathways.
  6. Non-steroidal anti-inflammatory drugs (NSAIDs): Used in eye drop form to reduce inflammation.
  7. Atropine eye drops: Helps with light sensitivity.
  8. Methotrexate: An immunosuppressant used in some cases.
  9. Tacrolimus: Suppresses immune responses.
  10. Plaquenil: An anti-inflammatory drug that can help manage symptoms.

Conclusion

Sympathetic Ophthalmia is a rare but potentially sight-threatening condition that can develop after eye injuries or surgeries. Early diagnosis and treatment are crucial in preserving vision and managing the condition effectively. If you experience any of the symptoms mentioned, seek immediate medical attention to prevent complications. With appropriate medical care and intervention, many individuals with SO can regain or maintain their visual health.

 

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. Thank you for giving your valuable time to read the article.

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