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OPHTHALMIA
Dr.Rajesh Babu B
Definition
Epidemiology
Theories of pathogenesis
Clinical manifestations
Symptoms
Examination findings
Complications
Pathology
Differential diagnosis
Fluorescein angiography findings
Treatment
Prognosis
SYMPATHETIC OPHTHALMIA
Sympathetic
ophthalmia is defined as a
bilateral granulomatous panuveitis that
occurs after the uvea of one eye is
subjected to a penetrating injury due to
either accidental trauma or surgery.
The term sympathetic ophthalmia was
coined by Mackenzie in the first half of the
19th century.
Definition
Incidence:
Prior to 1950 ~ 2% (16% during Civil War)
Retrospective studies: 0.2 - 0.5% after penetrating
trauma and 0.01% after intraocular surgery.
Prospective study: 0.03/100,000
Epidemiology
Albert D, Diaz-Rohena R. A historical review of sympathetic ophthalmia and its epidemiology.Survey Ophthalmology1989; 34:
114.
Kilmartin D, Dick A, Forrester J. Prospective surveillance of sympathetic ophthalmia in the UK and Republic of Ireland .Br J
Difficult
Prevalence
HISTORICAL
CURRENT
Cause
Post trauma
Patients
Incidence
Onset
Presentation
Granulomatous panuveitis
Inciting Eye
Visual Prognosis
Poor
Not
Streilein JW (ed):Ocular Immune Privilege-Protection that preserves sight. Karger Gazzete. The eye
in focus. No.64 http://www.karger.ch/gazette/64/streilein/index.htm accessed 1 Feb 2010
Streilein JW (ed): Immune Response and the Eye. Chem Immunol. Basel, Karger, 1999, vol 73.
The
Clinical manifestations
The
Clinical manifestations
SYMPTOMS
THE EARLIEST SYMPTOM MAY BE DECREASED
ACCOMMODATION AND THE EARLIEST SIGN,
RETROLENTICULAR FLARE AND CELLS IN THE FELLOW
EYE.
Irritable red eye with or without decreased vision.
Other symptoms include photophobia & transient
hyperopia.
Cutaneous and neurologic changes (alopecia, poliosis,
vitiligo, dysacousia, tinnitus, vertigo, and cells in the
cerebrospinal fluid), which are classically associated with
Vogt-Koyanagi-Harada syndrome, may rarely accompany
SO.
On examination
Although not
pathognomonic, are
quite suggestive of SO
and may indicate a more
severe stage of SO.
Dalen-Fuchs nodules
are small, discrete,
yellowish infiltrates
at the level of the RPE
that are most often seen
and are largest in the
retinal-choroidal
periphery.
Complications
Pathology
The
Dalen-Fuch's nodules
Multiple areas of
Early
Hyperfluorescence
and leakage at the
level of the RPE
(Dalen-Fuchs
nodules) and the
choroid (choroidal
granuloma) in most
cases, very similar to
those seen in
Harada's disease.
These sites (window
defects) correspond to
the Dalen-Fuchs
nodules observed
Presumably
the hyperfluorescent or hypofluorescent nature in the
clinically.
FLUORESCEIN ANGIOGRAPHY
CASELLA, Antnio Marcelo Barbante et al. Sympathetic ophthalmia histopathological correlation with fluorescein and indocyanine green
angiography: case report.Arq. Bras. Oftalmol.[online]. 2008, vol.71, n.6
[cited 2010-01-31], pp. 886-889
Disc hyperfluorescence
with blurring of
margins in late phase
Vogt-Koyanagi-Harada
syndrome
Phacoanaphylactic uveitis
Sarcoidosis
Chronic idiopathic uveitis
Other granulomatous uveitis induced by
mycobacteria or fungi
DIFFERENTIAL DIAGNOSIS
Sympathetic
Ophthalmia
Vogt-Koyanagi-Harada
Syndrome
Age
All ages
Racial predisposition
None
Penetrating trauma
Absent
Skin changes
Uncommon or unrelated
Common (60-90%)
CNS findings
Uncommon
Common (85%)
Hearing dysfunction
Uncommon
Common (75%)
Retinal serous
detachment
Uncommon
Frequently seen
Choriocapillaris
involvement
Usually absent
Frequently seen
CSF findings
Usually normal
Pleocytosis (84%)
Pharmacological Therapy
Current:
Corticosteroids - oral, periocular, intraocular, topical
Steroid-sparing agents - Imuran, Cellcept, Cyclosporine A
Prophylactic steroids do not prevent sympathetic
uveitis but can improve the visual outcome and can alter
the histopathologic features.
Treatment
Prognosis
Thank You
drrajeshbabu@yahoo.com