Sunday, November 8, 2026

2:30 PM - 2:45 PM

Ballroom 1 and 2

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Overview

Navdeep Kaur

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Details

BACKGROUND: Sympathetic ophthalmia is a bilateral autoimmune uveitis that occurs after surgical or accidental ocular trauma. The ocular trauma disrupts the eye's immune privilege, exposing previously isolated ocular autoantigens to the systemic immune system. This triggers a cell-mediated autoimmune response where antigen-presenting cells recruit T-lymphocytes, mistakenly targeting melanocyte-bearing tissues in both the injured and uninjured eye. Children, adult males, and elderly individuals are at higher risk likely due to their increased incidence of eye injuries and/or surgeries. Symptoms can appear anywhere from days to years after the initial event, with approximately 50% of patients developing them within three months and nearly 90% within 1 year. Presenting symptoms include eye pain, redness, severe photophobia, floaters and sudden blurred vision or loss of vision in the uninjured/untreated eye. Sympathetic ophthalmia poses a significant threat to long-term vision and can cause legal blindness in some individuals, making prompt medical intervention critical. Treatments involve rapidly controlling the immune response via high-dose systemic corticosteroids and other immunosuppressive medications to preserve vision and prevent further ocular damage. CLINICAL CASE: A 12-year-old male presented to the emergency department with a subconjunctival abscess following a penetrating pencil injury to the left eye. Ophthalmic examination raised concerns for a retained foreign body, infection and globe injury. Multimodal imaging of the injured left eye revealed severe inflammatory/infective changes, including retinal detachment with subretinal effusion, a thickened irregular enhancing retina with a focal defect suspicious for retinal tear/perforation, an abnormal lens and diffuse scleral involvement. No intraocular foreign body or intraconal/intracranial extension was identified. These findings were consistent with severe infective endophthalmitis progressing to panophthalmitis. Given the severity of the injury and prognosis for vision, the left eye was subsequently enucleated. At a review appointment approximately 8 weeks later, it was noted that the patient had developed severe uveitis in the right, uninjured eye. Treatment with oral prednisolone and topical corticosteroids was initiated. At a follow-up 3 weeks later, anterior chamber inflammation persisted alongside elevated intraocular pressure (IOP), requiring the addition of IOP-lowering eyedrops. Over the subsequent 4 weeks, IOP normalised, inflammation significantly improved to minimal trace cells, and visual acuity in the right eye was preserved at 6/6. CONCLUSION: Although sympathetic ophthalmia is rare, it remains a severe, sight-threatening condition across all age groups, including paediatric patients. As onset ranges from days to years after an initial event, presentation in the fellow eye may be easily misdiagnosed or overlooked if the link to prior ocular trauma or surgery is not recognised. Clinical attention frequently remains focused on the primary injured eye; however, this case highlights the critical need for careful monitoring of both eyes, particularly in young children, who may not recognise or communicate early monocular visual changes. Timely, comprehensive and ongoing monitoring of both eyes following unilateral ocular injury is essential for early diagnosis and sight preservation.

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Speaker