Sympathetic ophthalmia presenting 5 days after penetrating injury

Abstract

Purpose: To describe a rare case of early sympathetic ophthalmia that presented 5 days after penetrating injury.

Observations: A 13-year-old boy presented with a penetrating left globe injury from a BB metallic projectile that was emergently repaired. Five days later, routine dilated exam of the right eye revealed interval development of vitritis over the posterior pole. Optical coherence tomography revealed fine, vitreous hyper-reflective material. Intravenous and topical steroid therapy was started, and the patient underwent prompt enucleation of the traumatized eye. Histopathologic examination of the globe demonstrated lymphocytic choroiditis and macrophage infiltration, consistent with prior reports of early sympathetic ophthalmia. The sympathizing eye maintained 20/20 acuity and never caused visual complaints.

Conclusions and importance: This is the earliest reported case of sympathetic ophthalmia, to our knowledge, and it presented without visual symptoms only five days after penetrating trauma. This case suggests that routine examination should start before the typical 14 days associated with development of sympathetic ophthalmia.

Keywords: Pathology; Sympathetic ophthalmia; Trauma; Uveitis.

Fig. 1

Montage fundus photograph of the right eye taken 5 days after injury demonstrates new vitritis over the inferonasal macula (arrow) (A). Optical coherence tomography (OCT) demonstrates fine, hyper-reflective material in the vitreous, focal areas of hypotransmission due to vitreous opacity, and mild choroidal thickening.

Fig. 2

Fluorescein angiogram of the right eye demonstrates inferior vascular staining with mild leakage and mild leakage at the optic disc.

Fig. 3

Pathologic findings. (A) The choroid shows hemorrhage with erythrophages, lymphocytic choroiditis, and macrophage infiltration (H&E stain, 400x). (B) CD68 immunohistochemistry shows numerous macrophages, but no epithelioid histiocyte clusters (400x).