1. History
  2. Exam
  3. Photos
  4. Diagnosis
  5. Teaching Points
  6. Comments

Case 107 Teaching Points

  • Rare, bilateral, diffuse granulomatous uveitis made up of lymphocytic infiltration of the uveal tract with nests of epithelioid cells
  • Occurs a few days to several decades after penetrating accidental or surgical trauma to an eye
  • Both the “exciting” (traumatized) and “sympathizing” (fellow) eye are affected
  • Clinical signs and symptoms are usually detected within the first 3 months after trauma with the peak incidence 4 to 8 weeks after trauma
  • Signs and symptoms in the sympathizing eye are variable and may be subtle
  • Posterior segment findings include papillitis, generalized retinal edema, and small yellow-white deposits beneath the retinal pigment epithelium (Dalen-Fuchs nodules)
  • Fluorescein angiography typically shows multiple fluorescing dots at the level of the retinal pigment epithelium in the venous phase which persist (also seen in Vogt-Koyanagi-Harada syndrome)
  • In eyes with very poor visual potential and demonstrated disorganization of the ocular contents, enucleation within 2 weeks of injury is advised to prevent the disease
  • Enucleation of the exciting eye after the development of sympathetic ophthalmia is controversial and not shown to be of benefit
  • High dose steroids are the mainstay of therapy once the disease is present and should be continued for at least 6 months after the resolution of inflammation

References

Ryan SJ. Retina, 4th ed., Vol 3. Philadelphia:Mosby, 2006, pp 1821-1825.

Last Modified: Tuesday, 27-May-2008 14:52:27 EDT