Sympathetic uveitis in children: a case report and literature review
DOI:
https://doi.org/10.31288/oftalmolzh202165663Keywords:
sympathetic ophthalmia, trauma, childrenAbstract
Background: Sympathetic ophthalmia is a rare autoimmune disease that presents as a bilateral granulomatous uveitis following a traumatic event or, less commonly, uniocular surgery.
Purpose: To describe immunohistological and histomorphological data of a child who developed sympathetical ophthalmia in a healthy eye after a severe penetrating corneoscleral injury with contusion component.
Material and Methods: We present clinical observation data of a boy of 6.5 years who developed sympathetic ophthalmia in the left eye 1.5 months after a penetrating ocular injury caused by a tree branch resulted in a severe corneoscleral laceration in the right eye.
Types of treatment and data of clinical, imaging (ultrasound scanning and spectral-domain optical coherence tomography (SD-OCT)), pathohistological and immunological studies were described and reviewed.
Conclusion: A high index of clinical suspicion and careful monitoring of the state of not only a traumatized eye, but also the fellow eye both in the early and late period after traumatic event are vital to ensure identification of initial signs of sympathetic inflammation (photophobia and tearing) and taking prompt adequate measures for the prevention of further development of sympathetic inflammation. The use of current imaging modalities (including ultrasound scanning and especially SD-OCT of the retina and optic nerve) enables early documentation of the initial signs of sympathetic inflammation. Further research is warranted to develop the targeted treatment methods that would take into account the components of the immunopathogenesis.
References
1.Kumar K., Mathai A., Murthy S.I. Sympathetic ophthalmia in pediatric age group: clinical features and challenges in management in a tertiary center in Southern India. Ocul Immunol Inflamm. 2014 Oct;22(5):367-72.https://doi.org/10.3109/09273948.2013.841958
2.Bobrova NF. [Reconstructive eye surgery in children]. Odessa: Phoenix; 2013. Russian.
3.Arkhipova LT. [On the frequency of sympathetic ophthalmia. Myth and reality]. Russian Ophthalmological Journal. 2016; 9 (3): 95-100. Russian.
4.Albert DM, Diaz-Rohena R. A historical review of sympathetic ophthalmia and its epidemiology. Surv Ophthalmol. 1989; 34 (1):1-14.https://doi.org/10.1016/0039-6257(89)90125-2
5.Zaharia MA, Lamarche J, Laurin M. Sympathetic uveitis 66 years after injury. Can J Ophthalmol. 1984 Aug;19(5):240-3.
6.Williams AM, Shepler AM, Chu ChT, Nischal KK. Sympathetic ophthalmia presenting 5 days after penetrating injury. Am J Ophthalmol Case Rep. 2020 Jul 9;19:100816. doi: 10.1016/j.ajoc.2020.100816. eCollection 2020 Sep.https://doi.org/10.1016/j.ajoc.2020.100816
7.Chu XK, Chan Chi-Chao. Sympathetic ophthalmia: to the twenty-first century and beyond. J Ophthalmic Inflamm Infect. 2013 Jun 1;3(1):49.https://doi.org/10.1186/1869-5760-3-49
8.Goto H, Rao NA. Sympathetic ophthalmia and Vogt-Koyanagi-Harada syndrome. Int Ophthalmol Clin. Fall 1990;30(4):279-85.https://doi.org/10.1097/00004397-199030040-00014
9.Marak Jr GE. Sympathetic uveitis. In: Yanoff M, Duker JS, editors. 2nd ed. Mosby: St.Louis; 2004: 1205-8.
10.Chu DS, Foster CS. Sympathetic ophthalmia. Int Ophthalmol Clin. Summer 2002;42(3):179-85.https://doi.org/10.1097/00004397-200207000-00019
11.Kilmartin DJ, Dick AD, Forrester JV. Prospective surveillance of sympathetic ophthalmia in the UK and Republic of Ireland. Br J Ophthalmol. 2000 Mar;84(3):259-63.https://doi.org/10.1136/bjo.84.3.259
12.Su DH, Chee SP. Sympathetic ophthalmia in Singapore: new trends in an old disease. Graef Arch Clin Exp. 2006 Feb;244(2):243-7.https://doi.org/10.1007/s00417-005-0009-4
13.Ahmad N, Soong TK, Salvi S, Rudle PA, Rennie IG. Sympathetic ophthalmia after ruthenium plaque brachytherapy. Br J Ophthalmol. 2007; 91 (3):399-401.https://doi.org/10.1136/bjo.2006.102384
14.Arevalo JF, Garcia RA, Al-Dhibi HA, Sanchez JG, Suarez-Tata L. Update on sympathetic ophthalmia. Middle East Afr J Ophthalmol. 2012 Jan-Mar; 19(1): 13-21.https://doi.org/10.4103/0974-9233.92111
15.Bechrakis NE, Muller-Stolzenburg NW, Helbig H, Foerster MH. Sympathetic ophthalmia following laser cyclocoagulation. Arch Ophthalmol. 1994 Jan;112(1):80-4.https://doi.org/10.1001/archopht.1994.01090130090024
16.Brour J, Desjardins L, Lehoang P, Bodaghi B, Lumbroso-Lerouic L, Dendale R, Cassoux N. Sympathetic ophthalmia after proton beam irradiation for choroidal melanoma. Ocul Immunol Inflamm. 2012; 20 (4):273-6.https://doi.org/10.3109/09273948.2012.689072
17.Lubin JR, Albert DM, Weinstein M. Sixty-five years of sympathetic ophthalmia. A clinicopathologic review of 105 cases (1913-1978). Ophthalmology. 1980 Feb;87(2):109-21.https://doi.org/10.1016/S0161-6420(80)35270-6
18.Castiblanco C, Adelman RA. Imaging for sympathetic ophthalmia: impact on the diagnosis and management. Int Ophthalmol Clin. Fall 2012;52(4):173-81.https://doi.org/10.1097/IIO.0b013e318265d5c7
19.Damico FM, Kiss S, Young LH. Sympathetic ophthalmia. Semin Ophthalmol. Jul-Sep 2005;20(3):191-7.https://doi.org/10.1080/08820530500232100
20.Chan RV, Seiff BD, Lincoff HA, Coleman DJ. Rapid recovery of sympathetic ophthalmia with treatment augmented by intravitreal steroids. Retina. 2006 Feb;26(2):243-7.https://doi.org/10.1097/00006982-200602000-00029
21.Elschnig A. Studies on sympathetic ophthalmia, II: the antigenic effect of eye pigments. Graef Arch Clin Exp. 1910; 3: 365-456.
22.de Kozak Y, Sakai J, Thillaye B, Faure JP. S antigen-induced experimental autoimmune uveo-retinitis in rats. Curr Eye Res. 1981;1(6):327-37.https://doi.org/10.3109/02713688108998359
23.Schalken JJ, Winkens HJ, Van Vugt AH, De Grip WJ, Broekhuyse RM. Rhodopsin-induced experimental autoimmune uveoretinitis in monkeys. Br J Ophthalmol. 1989 Mar;73(3):168-72.https://doi.org/10.1136/bjo.73.3.168
24.Gery I, Wiggert B, Redmond TM, Kuwabara T, Crawford MA, Vistica BP, Chader GJ. Uveoretinitis and pinealitis induced by immunization with interphotoreceptor retinoid-binding protein. Invest Ophth Vis Sci. 1986 Aug;27(8):1296-300.
25.Gery I, Chanaud NP 3rd, Anglade E. Recoverin is highly uveitogenic in Lewis rats. Invest Ophth Vis Sci. 1994 Jul;35(8):3342-5.
26.Shindo Y, Ohno S, Usui M, Ideta H, Harada K, Masuda H, Inoko H. Immunogenetic study of sympathetic ophthalmia. Tissue Antigens. 1997 Feb;49(2):111-5.https://doi.org/10.1111/j.1399-0039.1997.tb02723.x
27.Bilyk JR. Enucleation, evisceration, and sympathetic ophthalmia. Curr Opin Ophthalmol. 2000 Oct;11(5):372-86.https://doi.org/10.1097/00055735-200010000-00015
28.Chaithanyaa N, Devireddy SK, Kishore Kumar RV, Gali RS, Aneja V. Sympathetic ophthalmia: a review of literature. Oral Surg Oral Med Oeal pathol Oral Radiol. 2012 Feb;113(2):172-6.https://doi.org/10.1016/j.tripleo.2011.01.036
29.Galor A, Davis JL, Flynn HW Jr, Feuer WJ, Dubovy SR, Setlur V, et al. Sympathetic ophthalmia: incidence of ocular complications and vision loss in the sympathizing eye. Am J Ophthalmol. 2009 Nov;148(5):704-710.e2.https://doi.org/10.1016/j.ajo.2009.05.033
30.Phan LT, Hwang TN, McCulley TJ. Evisceration in the modern age. Middle East Afr J Ophthalmol. 2012 Jan-Mar; 19(1): 24-33.https://doi.org/10.4103/0974-9233.92113
31.du Toit N, Motala MI, Richards J, Murray AD, Maitra S. The risk of sympathetic ophthalmia following evisceration for penetrating eye injuries at Groote Schuur Hospital. Br J Ophthalmol. 2008 Jan;92(1):61-3.https://doi.org/10.1136/bjo.2007.120600
32.Khramenko NI, Gaidamaka TB, Drozhzhyna GI, Velychko LN, Bogdanova AV. ICAM-1 expression on blood lymphocytes in patients with stromal herpes keratitis at different periods of disease. J Ophthalmol (Ukraine). 2020; 3: 23-8. Russian.https://doi.org/10.31288/oftalmolzh202032328
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Н. Ф. Боброва, С. А. Тронина, Е. В. Иваницкая, Л. Н. Величко, А. В. Артемов, А. В. Богданова
This work is licensed under a Creative Commons Attribution 4.0 International License.
This work is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) that allows users to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author as long as they cite the source.
COPYRIGHT NOTICE
Authors who publish in this journal agree to the following terms:
- Authors hold copyright immediately after publication of their works and retain publishing rights without any restrictions.
- The copyright commencement date complies the publication date of the issue, where the article is included in.
DEPOSIT POLICY
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) during the editorial process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work with an acknowledgement of its initial publication in this journal.
- Post-print (post-refereeing manuscript version) and publisher's PDF-version self-archiving is allowed.
- Archiving the pre-print (pre-refereeing manuscript version) not allowed.
