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Category: Volume 10 Issue 03 March 2022
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Title: A Case Report of Sympathetic Ophthalmitis

Authors: Dr Snigdha Gannamraju, Dr Sukitha Sangi, Dr Bala Harshitha Gavicherla, Dr Mahesh Pasham

 DOI: https://dx.doi.org/10.18535/jmscr/v10i3.12

Abstract

Introduction

William Mackenzie provided the first full clinical description of the disease coining the term Sympathetic Ophthalmitis(1)

Sympathetic Ophthalmitis is a rare bilateral non necrotising granulomatous uveitis.(2)

This occurs after perforating eye injury or ocular surgical procedure to one eye. The injured eye is exciting eye and the fellow eye developing inflammation days to years later is sympathising eye.

Although rare, Sympathetic Ophthalmitis remains an important public health problem because it can cause bilateral blindness.

Time from injury to onset varies greatly ranging from 1 week to 66 years,(3) within 1 month in 17% cases, within 3months in 50% cases, within 6 months in 65% cases, within first in after injury in 90% cases.

Incidence ranges from 0.2% to 0.5% following injury and 0.01% following intraocular surgery.(4) incidence has reduced in recent years due to meticulous repair of injured eye utilising microsurgical techniques and use of potent steroids.

The reason for naming this disease Sympathetic Ophthalmitis remains obscure. One possible explanation is that the sympathetic pathways (optic nerve and optic chiasma) may be the pathway from the inciting eye to the sympathising eye.(5) Other is the role of immune dysregulation as an etiology. There appears to be cell mediated immune response directed against ocular self antigens found on photoreceptors, RPE or choroidal melanocytes.

No racial or age predisposition. Incidence is equal in male and female after surgery. Disease occurs most frequently in males after trauma. This likely reflects difference in frequency of ocular injury between genders and more often after non surgical trauma(6).

Case Report

A 45 year old female patient came to Ophthalmology OPD with chief complaints of dragging type of pain in left eye since 20days. Diminution of vision for near since 20 days.

No history of trauma to left eye

History of trauma to right eye with stick 10 years ago while working in the fields, since then she developed gradual progressive painless diminution of vision in right eye. No other ocular complaints. No history of usage of glasses. No known systemic illness.

References

  1. Mackenzie W (1840)A practical treatise on the diseases of eye,3rd Longmans, London
  2. Albert DM, Diaz-Rohena R (1989) A historical review of sympathetic ophthalmia and its epidemiology. Surv ophthalmol 34(1):1-14
  3. Duke Elder S (1966) sympathetic ophthalmitis in: Duke Elder S (ed) Diseases of the uveal tract. Mosby , St. Louis, pp558-593
  4. Chan CC (1996) sympathetic ophthalmia. in: pepose JS GH, Wilhelmus KR (eds) ocular infection and immunology. Mosby, St. Louis.
  5. Chan CC,Roberg RG, Whitcup SM, Nussenblat RB (1995) 32 cases of sympathetic ophthalmia. A retrospective study at the National Eye Institute, Bethesda Md from 1982-1992. Arch ophthalmol 113(5):597-600.
  6. Mackley TA jr, Azar A (1978) sympathetic ophthalmia. A longterm follow up. Arch ophthalmo l96(2):257-262.
  7. Zaharia MA, Lamarche J, Laurin M (1984) sympathetic uveitis 66 years after injury. Can J ophthalmol 19(5):240-243
  8. Croxatto JO, Rao NA, McLean IW, Marak GE(1982)atypical histopathologic features in sympathetic ophthalmia. A study of a 100 cases. Int ophthalmol 4(3):129-135.
  9. Arevalo JF,Garcia RA, AI-Dhibi HA, Sanchez JG, Suarez-Tata L (2012) Update on sympathetic ophthalmia. Middle Eat Afr J Ophthalmol 19(1):13-21. doi:10.4103/0974-9233.92111.
  10. Chan CC, Benezra D, Rodrigues MM, Palestine AG, Hsu SM, Murphree AL, Nussenblatt RB (1985) Immunohistochemistry and electron microscopy of choroidal infiltrates and Dalen-Fuchs nodules in sympathetic ophthalmia. ophthalmology 92(4):580-590.
  11. Reynard M, Riffenburgh RS, Minckler DS (1985) Morphological variation of Dalen-Fuchs nodules in sympathetic ophthalmia. BrJ Ophthalmol 69(3):197-201.
  12. Shindo Y , Ohno S, Usui M, Ideta H, Harada K, Masuda H, Inoko H, (1997) Immunogenetic study of sympatheric ophthalmia. Tissue Antigens 49(2):111-115
  13. Subedi S (2005) sympathetic ophthalmia: a blinding complication of ocular injury. J Nepal Med Assoc 44(158):57-59.
  14. Damico FX, Kiss S, Young LH (2005) sympathetic ophthalmia, seminars in ophthalmology 20(3):191-197.
  15. Bilyk JR (2000) Enucleation, evisceration and sympathetic ophthalmia. Curr opin ophthalmol 11(5):372-386.

Corresponding Author

Dr Snigdha Gannamraju

Post Graduate, Department of Ophthalmology, Mamata Medical College, Khammam, Telangana