Sympathetic Ophthalmitis
Annie Mathai, Rajeev K Reddy,
Hemant S Trehan, Ritesh Narula
Smt.Kanuri Santhamma Retina Vitreous Centre,
Kallam Anji Reddy Campus,
L V Prasad Eye Institute,
Hyderabad
Ocular History
 48 year old man
 7-2007: decreased vision OS following injury
with stone 17 days earlier
 Diagnosed as globe rupture with uveal prolapse
 Underwent excision of prolapsed uveal tissue
and corneo-scleral tear repair
28th July 2007: First Presentation
 VA: OD - 20/20, OS - no PL
 OD - normal
 OS - red eye
 Corneo-scleral sutures
 Irregular AC
 AC details not clear
 Soft eye
 No fundus view
OS
Ultrasonography OS
 Funnel RD
 Choroidal thickening
 Peripheral choroidal
detachment
Diagnosis & management
 OD - normal
 OS - status post corneo-scleral tear repair, RD,
pre-phthisical eye
 Treatment OS:
 Prednisolone acetate eye drops 2 hourly
 Ofloxacin eye drops 4 hourly
 Atropine eye drops 3times/day
9th September 2007: Second Presentation
 Pain, redness, decreased vision OD x 3 days
 Seen elsewhere with shallow AC, raised IOP
 Diagnosed as angle closure glaucoma OD
 Underwent OD:YAG peripheral iridectomy
 Started on topical and systemic steroids (20mg)
9th September 2007: Second Presentation
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VA: OD - 2/60, OS - no PL
Anterior segment OD
AC: 1-2+ cells, 1+ flare
Sluggishly reacting pupil
3 attempted PIs
IOP - 10 mm Hg
OS findings same as before
9th September 2007: Second Presentation
 Fundus examination OD
 No vitreous cells
 Shallow serous
detachment at macula
 Diagnosed as CSCR
9th September 2007: B-scan & OCT
 Localised RD on B-scan & OCT
 No choroidal thickening on B-scan
9th September 2007: Diagnosis
 Acute central serous chorioretinopathy
precipitated by steroids
 Anterior uveitis secondary to PI
 Systemic steroids discontinued
 Topical steroids continued
 Called for review after 3 days
12th September 2007: 3 days later
 Visual acuity OD - 6/18
 AC - 2+ cells, 1+ flare
 No vitreous cells
 Fundus - shallow serous RD
 Topical steroids continued
 Called for review after 2 weeks
19th September 2007: 1 week later
 Seen in emergency
 Sudden decrease of vision OD
 Visual acuity - 1/60
 Fresh kps, 2+ cells, 2+ flare
 Fundus - serous RD
 Yellow subretinal lesions
Clinical diagnosis
 Symathetic ophthalmitis
 B-scan to look for choroidal thickness
 Fluorescein angiography
Ultrasonography
 Echo free vitreous cavity
 Localised shallow RD
 No choroidal thickening
Fluorescein angiography
27 sec
1min 9 sec
2 min 10 sec
4 min 40 sec
Fluorescein angiography
 Pin-point
hyperfluorescence
 Hyperfluorescence
increases in late phase
Final diagnosis & management
 Sympathetic ophthalmitis
 IV Methyl prednisolone 1 gm daily x 3 days
 Followed by oral prednisolone
 OU: Pred acetate eye drops 2 hourly
 OU: Homatropine eye drops 3 times/day
Response to treatment (OD)
 On 4th day visual acuity improved to 6/18
 In 10 days visual acuity was 6/6
 Serous RD completely resolved
 Topical and oral steroids continued
 Also started on Azothioprine 50 mg BD
Response to treatment - serous RD
Prior to treatment
Following treatment
Last follow-up
Visual acuity - 6/6
Conclusions
 Bilateral ocular involvement following open-globe
injuries ..........
 High alert for sympathetic ophthalmitis
 Fluorescein angiography is a crucial investigation
to confirm sympathetic ophthalmitis