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Sympathetic Ophthalmia
👁️🗨️ Sympathetic ophthalmia is a rare autoimmune condition. It famously occurred in Louis Braille (inventor of braille) after an eye injury, leading to bilateral blindness.
📖 About
- An autoimmune, type IV hypersensitivity reaction.
- Triggered by penetrating trauma or intraocular surgery to one eye.
- Results in autoimmune inflammation of the fellow (sympathising) eye.
🧬 Aetiology
- A granulomatous inflammatory response to melanin-containing ocular structures (e.g. photoreceptor outer segments).
- Develops after exposure of uveal antigens to the immune system following trauma or surgery.
🩺 Clinical Features
- History of penetrating trauma or intraocular surgery.
- Typically presents as a bilateral granulomatous panuveitis.
- Onset usually ~3 months after injury but can be delayed for years.
- Symptoms: pain, photophobia, conjunctival injection, marked ↓ visual acuity.
- Signs: mutton-fat keratic precipitates, Dalen-Fuchs nodules (epithelioid cell clusters between RPE and Bruch’s membrane).
🔎 Investigations
- Diagnosis is largely clinical (history + findings).
- OCT: assesses complications (retinal detachment, macular oedema).
- Fluorescein angiography: may show areas of inflammation or leakage.
💊 Management
- High-dose IV methylprednisolone in acute phase.
- Long-term immunosuppression (azathioprine, ciclosporin, cyclophosphamide).
- Enucleation of a painful, non-seeing injured eye may prevent further autoimmune activation.
📉 Prognosis
- Vision loss may be severe — complete bilateral blindness is possible.
- With prompt treatment, systemic immunosuppression can preserve some visual function in many patients.
📚 References
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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