Sympathetic Ophthalmia

Definition: Bilateral granulomatous panuveitis that occurs after surgery or penetrating injury to the other eye.

90% develop within 1 year.

Incidence of 0.2% after trauma & 0.01% after surgery.

Early treatment – 50% achieved 6/12 VA.

Late complications – secondary glaucoma, chronic maculopathy, phthisis bulbi.


  1. Bilateral AAU with mutton fat KPs (classical)
  2. Dalen-Fuchs nodules – white-yellowish lesions at RPE
  3. Exudative RD / ONH oedema / CNV / vasculitis / choroiditis / vitritis / CMO


  1. Good history and clinical examination.
  2. Investigative tools – FFA, ICG, OCT, USS
  3. High dose steroids (up to 2mg/kg/day) with gradual tailoring up to 3 months or pulse methylprednisolone (1g/day) for 3 days.
  4. Immunosuppressive therapy – cyclosporine, cyclophosphamide, azathioprine, chlorambucil.
  5. Intravitreal therapy – IVTA
  6. Prophylactic evisceration/enucleation of injured eye within 10 days.

Special note: With current surgical trend (especially VR surgery), any clinical uveitis in fellow eye – to consider this disease.


  1. Vogt-Koyanagi-Harada disease – usually Asian/blacks, no penetrating injury, with common skin and CNS changes and exudative RD and pleoyctosis in CSF.
  2. Sarcoidosis
  3. Syphilis


Location Birmingham Midlands Eye Centre 76 Dudley Road Birmingham B18 7QH UK Phone 0121 554 3801 Hours Mr Ch'ng | Vitreoretinal Clinic Sessions: Monday: 8.30am - 12.30pm Wednesday (alternate): 8.30am - 5.00pm Thursday: 8.30am - 12.30pm Friday: 8.30am - 12.30pm | Vitreoretinal Theatre Sessions: Wednesday (alternate): 8.30am - 5.00pm & Friday (emergency cases): 1.30pm - 5.00pm | Eye Casualty Session: Monday 1.00pm - 4.30pm |
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