Sympathetic ophthalmia
Sympathetic uveitis | |
---|---|
Other names | spared eye injury |
blindness |
Sympathetic ophthalmia (SO), also called spared eye injury, is a diffuse
Signs and symptoms
Pathophysiology
Sympathetic ophthalmia is currently thought to be an
Diagnosis
Diagnosis is clinical, seeking a history of eye injury. An important differential diagnosis is
Still experimental, skin tests with soluble extracts of human or bovine uveal tissue are said to elicit delayed hypersensitivity responses in these patients. Additionally, circulating antibodies to uveal antigens have been found in patients with SO and VKH, as well as those with long-standing uveitis, making this a less than specific assay for SO and VKH.
Treatment
Because SO is so rarely encountered following eye injury, even when the injured eye is retained, the first choice of treatment may not be enucleation or evisceration, especially if there is a chance that the injured eye may regain some function.[2] Additionally, with current advanced surgical techniques, many eyes once considered nonviable now have a fair prognosis.
However, only if the injured eye has completely lost its vision and has no potential for any visual recovery, prevention of SO is done by enucleation of the injured eye preferably within the first 2 weeks of injury. Evisceration—the removal of the contents of the globe while leaving the sclera and extraocular muscles intact—is easier to perform, offers long-term orbital stability, and is more aesthetically pleasing, i.e., a greater measure of movement of the prosthesis and thus a more natural appearance. There is concern, however, that evisceration may lead to a higher incidence of SO compared to enucleation.[3] Several retrospective studies involving over 3,000 eviscerations, however, have failed to identify a single case of SO.
Once SO is developed,
Epidemiology
Sympathetic ophthalmia is rare, affecting 0.2% to 0.5% of non-surgical eye wounds, and less than 0.01% of surgical penetrating eye wounds. There are no gender or racial differences in incidence of SO.
History
Although descriptions of sympathetic ophthalmia can be found in ancient Greek texts, modern understanding of SO derives from the works of Scotland's
It is thought that Louis Braille, who injured one of his eyes as a child, lost vision in his other eye owing to SO.[5] James Thurber's adult blindness was also diagnosed as sympathetic ophthalmia deriving from the loss of an eye when he was six years old.[6]
See also
References
- K. Barry Sharpless, in MIT Tech Talk; published March 19, 1992; retrieved May 10, 2016
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- ISBN 978-0-8385-6300-7.
- PMID 6478310.