Sympathetic ophthalmitis results due to:
Ans. A: Penetrating Injury of Ciliary Body Sympathetic ophthalmitis or ophthalmia almost always results from a penetrating wound. others Incarceration of the iris or lens capsule is more likely to set up sympathetic ophthalmitis than oers Sympathetic ophthalmia/ SO It is a granulomatous uveitis of both eyes following trauma to one eye. It can leave the patient completely blind. Symptoms may develop from days to several years after a penetrating eye injury. Floating spots and loss of accommodation are among the earliest symptoms. The disease may progress to severe iridocyclitis with pain and photophobia. Commonly the eye remains relatively painless while the inflammatory may occur. disease spreads through the uvea, where characteristic focal infiltrates in the choroid named Dalen-Fuchs nodules can be seen. Papilledema, secondary glaucoma, vitiligo, and poliosis of the eyelashes may accompany SO. In approximately 80% of cases, the uveitis appears within 2-12 weeks after injury, and 90% occur within 1 year from the time of injury. Sympathetic ophthalmia is currently thought to be an autoimmune inflammatory response toward ocular antigens, specifically a delayed hypersensitivity to melanin-containing structures from the outer segments of the photoreceptor layer of the retina. The immune system, which normally is not exposed to ocular antigens, is introduced to the contents of the eye following traumatic injury. Once exposed, it senses these antigens as foreign, and begins attacking them. The onset of this process can be from days to years after the inciting traumatic event. Diagnosis Diagnosis is clinical, seeking a history of eye injury. An impoant differential diagnosis is Vogt-Koyanagi-Harada syndrome (VKH), which is thought to have the same pathogenesis, without a history of surgery or penetrating eye injury. Prevention and treatment Definitive prevention of SO requires prompt (within the first 7 to 10 days following injury) enucleation of the injured eye. Evisceration--the removal of the contents of the globe while leaving the sclera and extraocular muscles intact--is easier to perform, offers long-term orbital stability, and is more aesthetically pleasing. There is concern, however, that evisceration may lead to a higher incidence of SO compared to enucleation The first choice of treatment may not be enucleation or evisceration, especially if there is a chance that the injured eye may regain some function Immunosuppressive therapy is the mainstay of treatment for SO. Mild cases may be treated with local application of coicosteroids and pupillary dilators. More severe or progressive cases require high-dose systemic coicosteroids for months to years. Patients who become resistant to coicosteroids or develop side effects of long-term coicosteroid therapy (osteoporosis and pathologic fractures, mental status changes, etc.), may be candidates for therapy with chlorambucil, cyclophosphamide, or ciclosporin.
Penetrating injury of ciliary body
Uveitis
Glaucoma
Trachoma