Sympathetic ophthalmia with bilateral vision loss: A case report

Abstract

Background

Sympathetic Ophthalmia [SO] is a rare condition with potentially devastating outcomes, characterized by bilateral uveitis following ocular trauma or surgery.

Findings

We present a case of a male in his 60s with no notable medical history who experienced bilateral vision loss following a traumatic injury. In 2006, the patient sustained trauma to his right eye after being elbowed by a patient, leading to a detached retina. Despite treatment with corticosteroids, immunomodulators, and multiple surgical interventions—including three buckle surgeries and two nitrous oxide gas treatments—the retina remained detached, resulting in complete vision loss and eventual enucleation of the right eye in 2012. Approximately one year later, the patient developed floaters and flashing lights in the left eye, diagnosed as a partial retinal tear, which was treated with laser therapy. Over the next decade, the left eye underwent six additional surgeries, immunotherapy, and participation in a clinical trial involving monthly intraocular injections to reduce swelling. Despite these efforts, intraocular pressure fluctuated significantly, reaching as high as 58 mmHg, and the patient ultimately lost all vision in the left eye by November 2023, requiring enucleation. Histopathology confirmed the diagnosis, and all tests for autoimmune conditions were negative. This case highlights the challenges of managing recurrent retinal detachment and refractory intraocular inflammation despite aggressive medical and surgical interventions.