Sympathetic ophthalmia is an exceedingly rare, bilateral diffuse granulomatous uveitis that develops following ocular penetrating trauma or surgery. Inflammation in the contralateral, unaffected eye develops days to years after the event, but usually occurs within three months of the injury.
Sympathetic ophthalmia is rare, affecting 0.2–0.5% of all traumatic penetrating eye injuries and 0.007% of patients after ocular surgery featuring a penetrating incision. The risk after pars plana vitrectomy is 0.01%.
Clinically, patients present with a bilateral severe, unremitting granulomatous panuveitis. There may be associated hypotony, small depigmented nodules at the level of the retinal pigment epithelium (Dalen–Fuch’s nodules), choroidal thickening, and serous retinal detachments (Fig. 17.5.1). Signs of prior injury or surgery in one eye are present.