Sympathetic ophthalmia

What it is

From: Orphanet

Sympathetic ophthalmia (SO) is a bilateral granulomatous anterior uveitis usually occurring within the three months following trauma or a surgical procedure involving one eye.

Reported clinical features and what the terms mean

The following findings are associated with this condition in Orphanet. They are not a checklist for diagnosing yourself, and they do not all occur in every affected person. Some are examination, imaging or laboratory findings that cannot be recognised at home.

The frequency labels describe how often a finding was reported among people with the condition in the source. They do not give the chance that a person with that symptom has the condition. Definitions below reproduce HPO terminology; they explain the term, not the likely severity in an individual.

Reduced visual acuity · Very frequent (99-80%)

Anterior chamber cells · Frequent (79-30%)

Tiny deposits corresponding to cells floating in the anterior chamber of the eye. This appearance is typically associated with intraocular inflammation leading to breakdown of the blood-aqueous barrier and resulting in an increase in the number of cells and in the aqueous humor. Grading (SUN Working Group) is performed by estimating the number of cells in a 1 mm by 1 mm slit beam field, employing adequate light intensity and magnification on a slit lamp.

Cataract · Frequent (79-30%)

A cataract is an opacity or clouding that develops in the crystalline lens of the eye or in its capsule.

Corneal keratic precipitates · Frequent (79-30%)

An inflammatory cellular deposit deposited on the corneal endothelium and visible as spots on the cornea.

Glaucoma · Frequent (79-30%)

Glaucoma refers loss of retinal ganglion cells in a characteristic pattern of optic neuropathy usually associated with increased intraocular pressure.

Retinal detachment · Frequent (79-30%)

Separation of the inner layers of the retina (neural retina) from the pigment epithelium.

Scleral thickening · Frequent (79-30%)

Increased dimension of the sclera in the anterior-posterior axis.

Vitritis · Frequent (79-30%)

Inflammation of the vitreous body, characterized by the presence of inflammatory cells and protein exudate in the vitreous cavity.

Alopecia · Occasional (29-5%)

A noncongenital process of hair loss, which may progress to partial or complete baldness.

Dalen Fuchs nodules · Occasional (29-5%)

Nodules (yellow-white subretinal pigment epithelium lesions) that form between Bruch membrane and the retinal pigment epithelium.

Erythema · Occasional (29-5%)

Redness of the skin, caused by hyperemia of the capillaries in the lower layers of the skin.

Headache · Occasional (29-5%)

Cephalgia, or pain sensed in various parts of the head, not confined to the area of distribution of any nerve.

Hearing impairment · Occasional (29-5%)

A decreased magnitude of the sensory perception of sound.

Macular edema · Occasional (29-5%)

Thickening of the retina that takes place due to accumulation of extracellular fluid in the macula as a nonspecific response to blood-retinal barrier breakdown. It can either have a cystoid aspect in the fovea, or a more diffuse aspect.

Other findings in the same source

From: Orphanet

Additional reported features include Ocular hypertension (Occasional (29-5%)); Ocular pain (Occasional (29-5%)); Papilledema (Occasional (29-5%)); Photophobia (Occasional (29-5%)); Poliosis (Occasional (29-5%)); Posterior synechiae of the anterior chamber (Occasional (29-5%)); Posterior uveitis (Occasional (29-5%)); Retinal hemorrhage (Occasional (29-5%)); Tinnitus (Occasional (29-5%)); Vitreous floaters (Occasional (29-5%)). This is a selected summary, not a complete description of the condition.

When it may begin

From: Orphanet

All ages

Inheritance in the source

From: Orphanet

Not applicable

Frequency and the population described

From: Orphanet

Annual incidence: <1 / 1 000 000; United Kingdom; Value and class.

Which doctor should you see?

The suggested department for discussing Sympathetic ophthalmia is Ophthalmology, with a ophthalmologist as the relevant type of clinician. Ophthalmologist; paediatric services for children as appropriate.

This is an editorial referral starting point. The appropriate clinic depends on the person’s age, symptoms, previous diagnosis and local services. The first clinician can decide whether another specialty or a team is needed; a department label does not confirm the diagnosis.

How to prepare for an assessment

Bring a short timeline of the main symptoms: when they first appeared, whether they are constant or episodic, what seems to change them, and how they affect daily activities. Include previous reports, discharge summaries, current medicines and supplements, allergies, and any relevant family history. A dated record is more useful than trying to match every feature in an online article.

Ask the clinician what is already established and what remains uncertain. If a test is suggested, ask what question it answers, what its limitations are and how the result would change the next step. The information here is not an instruction to arrange every possible test. In children, bring growth, developmental and school information if it is relevant to the concern.

• Which part of the eye or visual pathway is affected?
• What change in vision requires immediate contact with the eye service?
• What are the aims and alternatives of any proposed eye treatment?

Treatment discussions and follow-up

The material gathered for this draft does not provide a complete condition-specific treatment pathway for Sympathetic ophthalmia. That gap does not mean that treatment is unavailable. A clinician needs to establish the diagnosis and review current guidance before recommending medicines, procedures, rehabilitation or other support.

Before leaving the appointment, clarify the next review date, who will communicate results, and whom to contact if the situation changes. Discuss difficulties with sleep, work, school, mobility, eating or emotional wellbeing when these are relevant. Practical support may require coordination between the treating clinician and other services.

The collected references do not establish a complete prevention or long-term outlook section for this entry. Missing information should not be interpreted as proof that prevention is impossible or that a particular outcome is inevitable. Ask what is known for the exact subtype, stage and personal circumstances, and which uncertainties remain.

When to seek emergency help

Severe breathing difficulty, collapse, new stroke-like symptoms, a seizure that is prolonged or repeated without recovery, uncontrolled major bleeding, or an immediate risk of self-harm require emergency help. In India, call 112 or reach the nearest emergency department. This is a general, non-exhaustive warning list; it is not a condition-specific triage tool.