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Sympathetic ophthalmia (SO)

Sympathetic Ophthalmia (SO)Sympathetic ophthalmia (SO) is a rare, bilateral (affecting both eyes) inflammatory eye disease that typically occurs after trauma to one eye. It is a type of autoimmune condition in which the body's immune system mistakenly attacks the unaffected eye after the other eye has been injured, usually in a penetrating injury or surgical procedure. The condition can lead to serious complications, including permanent vision loss if not treated promptly.

Sympathetic Ophthalmia (SO)

Sympathetic ophthalmia (SO) is a rare, bilateral (affecting both eyes) inflammatory eye disease that typically occurs after trauma to one eye. It is a type of autoimmune condition in which the body's immune system mistakenly attacks the unaffected eye after the other eye has been injured, usually in a penetrating injury or surgical procedure. The condition can lead to serious complications, including permanent vision loss if not treated promptly.

Causes of Sympathetic Ophthalmia

The exact cause of sympathetic ophthalmia is not fully understood, but it is believed to be an autoimmune response. When an eye sustains a traumatic injury or surgery, the body may release proteins from the damaged eye’s tissues, which can be recognized as foreign by the immune system. The immune system then targets similar proteins in the unaffected eye, leading to inflammation and damage.

Some common triggers include:

  1. Penetrating Eye Injuries:
    • Injuries where the eye is pierced or ruptured (such as from a foreign object like glass or metal).
  2. Eye Surgery:
    • Surgical procedures like cataract surgery or retinal detachment repair can sometimes lead to sympathetic ophthalmia.
  3. Infections:
    • Certain infections that affect the eye may also trigger sympathetic ophthalmia.
  4. Unexplained Trauma:
    • Even non-penetrating trauma to the eye can occasionally lead to the development of sympathetic ophthalmia.

Symptoms of Sympathetic Ophthalmia

The symptoms of sympathetic ophthalmia can range from mild to severe and typically develop in the uninjured (or "sympathetic") eye weeks to months after the original eye injury or surgery. Common symptoms include:

  • Blurred vision: Gradual or sudden loss of vision in one or both eyes.
  • Eye pain: Mild to moderate pain in the unaffected eye.
  • Redness: Inflammation causing the eye to appear red.
  • Sensitivity to light (photophobia): The affected eye may become more sensitive to bright lights.
  • Floaters: Small spots or lines that appear in the field of vision.
  • Decreased vision: Over time, vision may become progressively worse, and permanent vision loss can occur if not treated effectively.

Diagnosis of Sympathetic Ophthalmia

Diagnosing sympathetic ophthalmia involves a combination of clinical examination and tests to rule out other causes of eye inflammation. Key diagnostic methods include:

  1. Comprehensive Eye Exam:
    • The eye specialist (ophthalmologist) will perform a detailed eye examination to assess the degree of inflammation, looking for signs such as uveitis (inflammation of the uvea) and damage to the retina.
  2. Fundus Exam:
    • A fundus exam (dilating the pupil) allows the ophthalmologist to look at the back of the eye (the retina) to check for changes such as choroiditis (inflammation of the choroid) and other signs of inflammation.
  3. Fluorescein Angiography:
    • This test involves injecting a dye into a vein and using a special camera to observe how the dye moves through the blood vessels in the eye. It helps assess the extent of damage to the retina.
  4. Optical Coherence Tomography (OCT):
    • OCT imaging may be used to capture detailed images of the retina and other structures inside the eye to evaluate inflammation and tissue damage.
  5. Blood Tests:
    • Blood tests may be used to rule out systemic infections or other autoimmune conditions that could mimic the symptoms of sympathetic ophthalmia.

Treatment of Sympathetic Ophthalmia

The treatment for sympathetic ophthalmia typically involves suppressing the immune system to prevent further damage to the eyes. Common treatments include:

  1. Corticosteroids:
    • Oral steroids or topical eye drops are often the first line of treatment to reduce inflammation and control symptoms. In some cases, intravitreal injections (steroid injections directly into the eye) may be used for more severe cases.
  2. Immunosuppressive Drugs:
    • For cases that do not respond to steroids, other immunosuppressive medications like methotrexate, cyclophosphamide, or azathioprine may be prescribed to control the immune response.
  3. Biologic Agents:
    • Biologic therapies, such as TNF inhibitors, may be considered for more severe or refractory cases that do not respond to conventional treatments.
  4. Surgical Intervention:
    • In some instances, if the disease causes cataracts or retinal damage, surgical intervention may be necessary to treat complications.

Prognosis

The prognosis for sympathetic ophthalmia depends on the severity of the inflammation and the promptness of treatment. Early diagnosis and appropriate treatment are crucial in preventing permanent vision loss. If left untreated, sympathetic ophthalmia can result in:

  • Severe vision loss: Both eyes may experience permanent damage, leading to blindness.
  • Glaucoma: Increased intraocular pressure due to chronic inflammation can damage the optic nerve.
  • Retinal damage: Chronic inflammation can lead to retinal scarring and detachment.

However, with timely and aggressive treatment, many patients can maintain functional vision in one or both eyes.

Prevention

There is no guaranteed way to prevent sympathetic ophthalmia, but reducing the risk of eye injury and promptly treating any eye trauma can help lower the likelihood of developing this condition. Immediate medical attention following any eye injury or surgery, as well as follow-up care, can help reduce the risk of complications.

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