Case 50: Sympathetic Ophthalmia After Open Globe Repair

Abstract

A 53-year-old man presented with a zone III ruptured open-globe of the left eye from a spring-loaded piece of an antique car door. Examination was notable for a 20 mm temporal scleral rupture extending posteriorly with uveal prolapse. The patient underwent repair of this open-globe injury followed by pars plana vitrectomy (PPV) for retinal incarceration and retinal detachment with a giant retinal tear and repeat PPV for anterior chamber intraocular lens placement. Two months following his second PPV, he presented with a visual acuity of 20/400 in the right eye and found to have panuveitis and serous retinal detachments of the right eye. The patient was diagnosed with sympathetic ophthalmia and started on high dose steroid therapy and mycophenolate. His visual acuity returned to 20/20 in the right eye 1 month after starting therapy. Sympathetic ophthalmia, a bilateral granulomatous panuveitis, is a rare condition that can occur after ocular trauma or intraocular surgery. Counseling patients about the risk of sympathetic ophthalmia should occur prior to performing open-globe repair.