Sympathetic Ophthalmia

Overview

Sympathetic ophthalmia is a rare but serious form of uveitis, or inflammation inside the eye, that affects both eyes after one eye has been injured or undergone surgery. The injured eye is called the "exciting" eye, and the other, previously healthy eye that becomes inflamed is called the "sympathizing" eye.

The condition is thought to be an autoimmune reaction: after an eye injury exposes certain internal eye tissues to the immune system, the body may mistakenly attack similar tissue in both eyes. Sympathetic ophthalmia can develop weeks, months, or even years after the original injury. Because it threatens the vision of the uninjured eye, prompt recognition and treatment are critical.

Sympathetic ophthalmia is rare, even after serious eye injuries or surgery, but its potential to affect the only remaining good eye makes it especially important. Anyone who has had a penetrating eye injury or eye operation should be aware of the warning signs and report new eye symptoms promptly, even years later. Early treatment offers the best chance of preserving useful vision and controlling the inflammation before lasting damage occurs.

Symptoms

Symptoms usually involve the previously healthy eye and may come on gradually. They can include:

• Blurred or decreased vision in the uninjured eye
• Eye pain or aching
• Redness
• Sensitivity to light (photophobia)
• Floaters or difficulty focusing

Some people also notice headache, and in some cases features outside the eye, such as skin or hearing changes, may occur. Any new eye symptoms in a person with a history of eye injury or surgery deserve urgent evaluation.

Causes

Sympathetic ophthalmia is believed to be an autoimmune response triggered by injury to one eye. The leading explanation is that:

• Penetrating eye trauma: A wound that opens the eye exposes internal eye proteins (such as those in the light-sensing tissue) to the immune system.
• Intraocular surgery: Certain eye operations can similarly expose these proteins.
• Immune cross-reaction: The immune system then attacks these proteins in both the injured and the healthy eye, causing inflammation in both.

It is not an infection and is not contagious. The interval between the triggering event and the onset of inflammation varies widely, from days to many years.

Risk Factors

• A penetrating (open) injury to the eye
• Previous eye surgery, especially multiple or complex procedures
• Severe eye trauma with damage to internal structures

Sympathetic ophthalmia is rare even after such injuries, but the risk underlies the careful follow-up advised after significant eye trauma or surgery.

Diagnosis

Diagnosis relies on the history of eye injury or surgery plus signs of inflammation in the other eye. Evaluation may include:

• Detailed eye examination: Looking for the characteristic pattern of inflammation inside both eyes.
• Imaging of the eye: Such as scans of the retina to detect inflammation and fluid.
• History review: Identifying the timing of any prior trauma or surgery.
• Tests to exclude other causes: Blood tests to rule out infections and other forms of uveitis.

Treatment

Treatment aims to control the inflammation quickly to protect sight. Approaches include:

• Corticosteroids: High-dose oral, injected, or sometimes intravenous steroids to suppress inflammation.
• Steroid-sparing immune medicines: Used for long-term control and to reduce steroid side effects.
• Specialist follow-up: Ongoing monitoring, since the condition can be chronic and relapse.

In some cases, when an injured eye has no useful vision and is severely damaged, removing it early may be considered to reduce the risk, but this is an individualized decision made with a specialist. Once sympathetic ophthalmia has developed, treatment focuses on controlling inflammation in both eyes rather than on the injured eye alone, and care is usually shared between an eye specialist and a doctor experienced in immune-suppressing therapy.

When to See a Doctor

Seek urgent eye care if you have had an eye injury or eye surgery and develop new symptoms in either eye, including:

• Blurred or decreasing vision
• Eye pain, redness, or light sensitivity
• New floaters or a change in vision

Because sympathetic ophthalmia can threaten the sight of the healthy eye, early treatment is essential. Do not delay evaluation, even if the injury was long ago.

Related Topics

Frequently Asked Questions

References

1. American Academy of Ophthalmology. Sympathetic ophthalmia.
2. National Eye Institute (NEI). Uveitis.
3. MedlinePlus, U.S. National Library of Medicine. Uveitis.