Delayed Sympathetic Ophthalmia Involving Posterior Segment a Dilemma: A Case Report

Abstract

We report a case of 11 year old young girl referred with complaint of right sided photophobia and pain following faucet induced trauma to left eye 3 months ago, followed by loss of sight in left eye. Patient presented to us with prepthisical left eye and anterior segment uveitis in right eye. Fundus picture revealed cream colour white nodules confirmed as Dalen Fuchs on fundus fluorescein angiography and presence of hypereflective lesions placed at level of retinal pigment epithelium with disruption of the inner and outer segment (IS/OS) junction on spectral domain optical coherence tomography. Ultrasonogram-B-scan confirmed closed funnel retinal detachment in traumatized left eye and increased choroidal thickness in sympathizing right eye. She underwent orbital computerized axial tomography scan to rule out intraocular foreign body. She was diagnosed as a case of delayed sympathetic ophthalmia. Subsequently she was put on intensive topical with oral steroids and immunesuppressive therapy constituted with oral azathioprine and methotrexate continued for one year and tapered on resolution of presenting signs. At final follow up sympathizing eye was quiescent and sympathetic eye was prepthisical. Sympathetic ophthalmia needs to be distinguished from other ocular auto-immune disorder such as Vogt Koyanagi Harada disease and Acute Multifocal Pigment Placoid Epitheliopathy to which it bears striking resemblance. As these disorders have variable response to treatment with widely differing outcome one must keep that in view while managing them. It is important to remember as the treatment is prolonged recurrences and patient drop outs are commonly noted.