Sympathetic Ophthalmia

What's going on?

This is rare. The eye is in the privileged position of being separated from the body's immune system by the tight blood-retinal barrier. When this barrier is broken by trauma or even surgery, the retinal antigens are exposed to the immune system and the body becomes sensitised. Weeks, months or even years after an eye injury or surgery, the body can react against the other, normal eye, causing severe, potentially blinding inflammation. After severe blinding ocular injury, removal of the damaged eye within two weeks is thought to protect against this disastrous complication.

If I examine the patient, what will I find?

The eye with no history of injury will be red and inflamed. The redness will be around the limbus because the inflammation is inside the eye. Vision may be reduced.

What if I've diagnosed it?

This is a sight-threatening problem that may affect the patient's only good eye, the other having been injured. Refer urgently.

What will the hospital do?

High-dose topical and systemic steroids will be required to stop the inflammatory process. Some patients require formal systemic immunosuppression.