Introduction: Sympathetic ophthalmia (SO) is a rare, vision-threatening, bilateral, granulomatous uveitis that occurs following trauma or surgery to one eye. This article aims to provide a comprehensive review of SO, including its pathophysiology, clinical presentation, diagnostic approach, treatment strategies, and recent advancements in research.

Pathophysiology: SO is believed to result from an aberrant immune response triggered by the release of intraocular antigens following trauma or surgery to one eye. These antigens stimulate an inflammatory cascade, leading to the activation of T lymphocytes and the production of cytokines, which subsequently target and damage the contralateral healthy eye.

Clinical Presentation: The clinical presentation of SO typically involves bilateral granulomatous uveitis, characterized by:

• Photophobia
• Blurred vision
• Redness
• Floaters
• Decreased visual acuity
• Conjunctival injection
• Keratic precipitates
• Vitritis
• Optic disc swelling (papillitis)

Diagnostic Approach: Diagnosing SO requires a thorough evaluation, including:

• Comprehensive ophthalmic examination
• Medical history, with specific attention to prior ocular trauma or surgery
• Imaging studies such as optical coherence tomography (OCT) and fluorescein angiography
• Laboratory tests including serological markers for uveitis (e.g., antinuclear antibodies, HLA typing)
• Histopathological examination of intraocular tissues (if available)

Treatment Strategies: Management of SO aims to suppress inflammation, preserve vision, and prevent recurrence. Treatment modalities may include:

• High-dose systemic corticosteroids to control inflammation
• Immunosuppressive agents such as methotrexate, azathioprine, or mycophenolate mofetil to achieve steroid-sparing effects
• Biologic agents targeting specific inflammatory pathways (e.g., TNF-α inhibitors) for refractory cases
• Local periocular or intravitreal corticosteroid injections for macular edema or severe inflammation
• Surgical intervention (e.g., pars plana vitrectomy) for complications such as vitreous hemorrhage or tractional retinal detachment

Recent Advancements: Recent advancements in SO research have focused on elucidating its pathogenesis and identifying novel therapeutic targets. Promising areas of investigation include:

• Targeted immunomodulatory therapies aiming to selectively modulate immune responses and prevent autoimmune-mediated damage to ocular tissues
• Gene therapy approaches to induce ocular immune tolerance and prevent disease recurrence
• Biomarker discovery to identify individuals at risk of developing SO and monitor treatment response

Reference Sites:

1. American Uveitis Society (AUS) – https://www.uveitissociety.org/
2. National Eye Institute (NEI) – https://www.nei.nih.gov/
3. British Ophthalmological Surveillance Unit (BOSU) – https://www.bosu.org.uk/

By raising awareness of SO and highlighting recent advancements in its diagnosis and treatment, this article aims to empower healthcare professionals in their efforts to effectively manage and treat this rare but potentially devastating condition. With continued research and collaborative efforts, the prognosis for individuals with SO continues to improve, offering hope for improved outcomes and quality of life.