1. Sympathetic Ophthalmitis
Annie Mathai, Rajeev K Reddy,
Hemant S Trehan, Ritesh Narula
Smt.Kanuri Santhamma Retina Vitreous Centre,
Kallam Anji Reddy Campus,
L V Prasad Eye Institute,
Hyderabad

2. Ocular History 48 year old man
7-2007: decreased vision OS following injury with stone 17 days earlier
Diagnosed as globe rupture with uveal prolapse
Underwent excision of prolapsed uveal tissue and corneo-scleral tear repair

3. 28th July 2007: First Presentation
VA: OD - 20/20, OS - no PL
OD - normal
OS - red eye
Corneo-scleral sutures
Irregular AC
AC details not clear
Soft eye
No fundus view OS

4. Ultrasonography OS Funnel RD Choroidal thickening
Peripheral choroidal detachment

5. Diagnosis & management
OD - normal
OS - status post corneo-scleral tear repair, RD, pre-phthisical eye
Treatment OS:
Prednisolone acetate eye drops 2 hourly
Ofloxacin eye drops 4 hourly
Atropine eye drops 3times/day

6. 9th September 2007: Second Presentation
Pain, redness, decreased vision OD x 3 days
Seen elsewhere with shallow AC, raised IOP
Diagnosed as angle closure glaucoma OD
Underwent OD:YAG peripheral iridectomy
Started on topical and systemic steroids (20mg)

7. 9th September 2007: Second Presentation
VA: OD - 2/60, OS - no PL
Anterior segment OD
AC: 1-2+ cells, 1+ flare
Sluggishly reacting pupil
3 attempted PIs
IOP - 10 mm Hg
OS findings same as before

8. 9th September 2007: Second Presentation
Fundus examination OD
No vitreous cells
Shallow serous detachment at macula
Diagnosed as CSCR

9. 9th September 2007: B-scan & OCT
Localised RD on B-scan & OCT
No choroidal thickening on B-scan

10. 9th September 2007: Diagnosis
Acute central serous chorioretinopathy precipitated by steroids
Anterior uveitis secondary to PI
Systemic steroids discontinued
Topical steroids continued
Called for review after 3 days

11. 12th September 2007: 3 days later
Visual acuity OD - 6/18
AC - 2+ cells, 1+ flare
No vitreous cells
Fundus - shallow serous RD
Topical steroids continued
Called for review after 2 weeks

12. 19th September 2007: 1 week later
Seen in emergency
Sudden decrease of vision OD
Visual acuity - 1/60
Fresh kps, 2+ cells, 2+ flare
Fundus - serous RD
Yellow subretinal lesions

13. Clinical diagnosis Symathetic ophthalmitis
B-scan to look for choroidal thickness
Fluorescein angiography

14. Ultrasonography Echo free vitreous cavity Localised shallow RD
No choroidal thickening

15. Fluorescein angiography
27 sec
1min 9 sec
2 min 10 sec
4 min 40 sec

16. Fluorescein angiography
Pin-point hyperfluorescence
Hyperfluorescence increases in late phase

17. Final diagnosis & management
Sympathetic ophthalmitis
IV Methyl prednisolone 1 gm daily x 3 days
Followed by oral prednisolone
OU: Pred acetate eye drops 2 hourly
OU: Homatropine eye drops 3 times/day

18. Response to treatment (OD)
On 4th day visual acuity improved to 6/18
In 10 days visual acuity was 6/6
Serous RD completely resolved
Topical and oral steroids continued
Also started on Azothioprine 50 mg BD

19. Response to treatment - serous RD
Prior to treatment
Following treatment

20. Last follow-up
Visual acuity - 6/6

21. Conclusions
Bilateral ocular involvement following open-globe injuries
High alert for sympathetic ophthalmitis
Fluorescein angiography is a crucial investigation to confirm sympathetic ophthalmitis