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Pathology of Sympathetic-Ophthalmia

(Sympathetic Uveitis)

Dr Sampurna Roy MD 

 

 

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Sympathetic ophthalmia is a rare, bilateral granulomatous uveitis that occurs after either surgical or accidental trauma to one eye.

The ocular inflammation in the fellow eye becomes apparent usually within 3 months after injury. 

Clinical presentation is an insidious or acute anterior uveitis with mutton-fat keratic precipitates.

The posterior segment manifests moderate to severe vitritis, usually accompanied by multiple yellowish-white choroidal lesions.

Evidence suggests that sympathetic ophthalmia represents an autoimmune inflammatory response against choroidal melanocytes mediated by T cells.

Diagnosis is based on clinical findings and a history of previous ocular trauma or surgery.

Classic histopathological features:  The inflammatory changes in both eyes consist of a diffuse, granulomatous proliferation throughout the uveal tract and subretinal pigment epithelium collections of inflammatory cells (Dalen-Fuchs nodules). Bone marrow derived monocytes are the major cellular components in these granulomas.

The inflammatory infiltrate is composed of lymphocytes and plasma cells, with a variable number of epithelioid and giant cells.

Corticosteroid therapy may modify this picture.

The epithelioid cells contain phagocytosed pigment granules, but there is no sign of necrosis.

Eosinophils appear early in the course of the disease and disappear late.

The granulomatous inflammation may spread to involve the optic nerve sheath,the nerve itself, the scleral emissaria, and the scleral stroma.

Dalén-Fuchs nodules appear early peripherally, and it is over these nodules that retinal granulomas, when present, usually are found.

Visit: Uveitis ; Granulomatous Uveitis ; Vogt-Koyanagi-Harada syndrome ; Sympathetic ophthalmia

 

Further reading

Sympathetic ophthalmia : a blinding complication of ocular injury.

Sympathetic ophthalmia caused by a severe ocular chemical burn: a case report and literature review.

Development of sympathetic ophthalmia following globe injury.

Atypical histopathologic features in sympathetic ophthalmia. A study of a hundred cases.

Sympathetic ophthalmia in HIV infection. A clinicopathological case report.

Sympathetic ophthalmia in Singapore: new trends in an old disease.

Sympathetic ophthalmia - histopathological correlation with fluorescein and indocyanine green angiography: case report.

Sympathetic ophthalmia.

[Sympathetic ophthalmia. Clinical and morphological study in 6 cases after penetrating injury and subsequent repeated vitreoretinal operations].

Thirty-year history of sympathetic ophthalmia.

Atypical histopathologic features in sympathetic ophthalmia. A study of a hundred cases.

Pigmentation associated histopathological variations in sympathetic ophthalmia.

Sympathetic ophthalmia: a comparison of the histopathological features from a Chinese and American series.

Immunohistochemistry and electron microscopy of choroidal infiltrates and Dalen-Fuchs nodules in sympathetic ophthalmia.

Sympathetic ophthalmia. Immunopathological findings.

Sympathetic ophthalmia: an immunohistochemistry study of four cases.

Sympathetic ophthalmia. Clinical and morphological study in 6 cases after penetrating injury and subsequent repeated vitreoretinal operations

SYMPATHETIC OPHTHALMIA: Clinicopathologic Correlation in a Consecutive Case Series.

 

 

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Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)


 

 

 

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