Uveitis
Sympathetic ophthalmia
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Get access- Rare bilateral granulomatous panuveitis: very similar to VKH but is related to antecedent trauma
- Can arise from within a few days to years after the injury
- T cell mediated response to ocular antigens
- 0.1% of penetrating trauma
- 0.01% of routine vitrectomy
Clinical features
- Bilateral granulomatous anterior uveitis
- Posterior uveitis: Dalen’ Fuch’s nodules, macular oedema
- Systemic features: as for VKH but less common
Prevention
- Enucleation within 10 days of trauma is thought to potentially prevent sympathetic ophthalmia, but is not routinely carried out after penetrating trauma for this purpose
Management
- Some suggest enucleation within 2 weeks of symptoms can improve the outcome
- High dose systemic corticosteroids, either oral pred or IVMP
- Steroid-sparing agents: methotrexate, azathioprine, ciclosporin, MMF, tacrolimus