Sympathetic Ophthalmia: Part I

Abstract

This paper, which is a lecture given (by invitation) at the Postgraduate Course in Ophthalmology at the University of Rochester in New York, covers the important observations and views on this much-discussed subject. In it the author compares the data derived from the reports on this subject by Fuchs, Joy, and Verhoeff, and adds his own observations on twenty-eight cases, in fifteen of which the diagnosis was confirmed by histological study. It will appear in two parts. In the first part are treated the history, definition, and incidence of the disease, its predisposing causes and the clinical picture in the exciting eye, the interval between injury of the exciting eye and onset of the disease, the clinical picture in the sympathizing eye, and the duration of the disease. Causes other than penetrating wounds have induced the disease in seven authenticated cases observed by the writers whose data are tabulated for comparative purposes, among them one of his own. The type of trauma which the author regards as most grave in threatening sympathetic ophthalmia is the penetrating wound that involves the root of the iris or the ciliary region. The interval between injury to the exciting eye and onset of the disease in approximately 64 percent of the 129 cases discussed was under two months, and it appears that after three months have elapsed the chances for its development rapidly decline. However, assuming that no second injury has affected the exciting eye, it must be considered that long-delayed sympathetic ophthalmia is a clear-cut clinical entity. There is nothing characteristic in the exciting eye to point to a threatening of the second eye. In the author's opinion the salient characteristic clinically in the sympathizing eye is the massiveness and rather intermittent progress of cellular reaction in contrast to the low intensity of vascular and inflammatory reaction. From the Wilmer Ophthalmological Institute of the Johns Hopkins University and Hospital. This paper, which is a lecture given (by invitation) at the Postgraduate Course in Ophthalmology at the University of Rochester in New York, covers the important observations and views on this much-discussed subject. In it the author compares the data derived from the reports on this subject by Fuchs, Joy, and Verhoeff, and adds his own observations on twenty-eight cases, in fifteen of which the diagnosis was confirmed by histological study. It will appear in two parts. In the first part are treated the history, definition, and incidence of the disease, its predisposing causes and the clinical picture in the exciting eye, the interval between injury of the exciting eye and onset of the disease, the clinical picture in the sympathizing eye, and the duration of the disease. Causes other than penetrating wounds have induced the disease in seven authenticated cases observed by the writers whose data are tabulated for comparative purposes, among them one of his own. The type of trauma which the author regards as most grave in threatening sympathetic ophthalmia is the penetrating wound that involves the root of the iris or the ciliary region. The interval between injury to the exciting eye and onset of the disease in approximately 64 percent of the 129 cases discussed was under two months, and it appears that after three months have elapsed the chances for its development rapidly decline. However, assuming that no second injury has affected the exciting eye, it must be considered that long-delayed sympathetic ophthalmia is a clear-cut clinical entity. There is nothing characteristic in the exciting eye to point to a threatening of the second eye. In the author's opinion the salient characteristic clinically in the sympathizing eye is the massiveness and rather intermittent progress of cellular reaction in contrast to the low intensity of vascular and inflammatory reaction. From the Wilmer Ophthalmological Institute of the Johns Hopkins University and Hospital.