Summary about Disease
Sympathetic uveitis (SU) is a rare, bilateral granulomatous inflammation of the entire uveal tract (iris, ciliary body, and choroid) that occurs after penetrating ocular trauma or surgery to one eye. The injured eye is referred to as the exciting eye, and the other eye, which develops the disease secondarily, is called the sympathizing eye. SU is an autoimmune response directed against retinal antigens that are normally sequestered from the immune system.
Symptoms
Symptoms usually develop in the uninjured eye (sympathizing eye), though the injured eye (exciting eye) may still show signs of inflammation. Common symptoms include:
Blurred vision
Eye pain
Redness
Photophobia (sensitivity to light)
Floaters
Decreased visual acuity
Causes
Sympathetic uveitis is caused by a penetrating injury or surgery to one eye. This breach releases intraocular antigens (specifically retinal antigens) that the immune system recognizes as foreign. This triggers an autoimmune response that attacks the uveal tissue in both the injured (exciting) eye and the uninjured (sympathizing) eye. The exact mechanism is not fully understood, but it is believed to involve T-cell mediated immunity.
Medicine Used
Treatment focuses on suppressing the immune system to prevent further damage to the eyes. Medications commonly used include:
Corticosteroids: Prednisone (oral), prednisolone acetate (eye drops) are used to reduce inflammation.
Immunosuppressants: These medications, such as methotrexate, azathioprine, mycophenolate mofetil, cyclosporine, and adalimumab are used to suppress the immune system and prevent further damage.
Is Communicable
No, sympathetic uveitis is not communicable. It is an autoimmune condition and cannot be spread from person to person.
Precautions
There are no specific precautions to prevent SU in the general population, as it is related to eye trauma or surgery. However, prompt and appropriate treatment of severe eye injuries can reduce the risk. Enucleation (removal) of the injured eye may be considered in severe cases with no visual potential, particularly early in the course of the disease, to prevent the development of SU in the other eye.
How long does an outbreak last?
Without treatment, sympathetic uveitis can be a chronic and progressive condition. With treatment, the duration of symptoms can vary. Some individuals may achieve remission with long-term immunosuppression, while others may experience relapses. Treatment duration can range from months to years, and sometimes lifelong.
How is it diagnosed?
Diagnosis is based on a combination of factors:
History: A history of penetrating eye injury or surgery in one eye.
Clinical Examination: Examination of both eyes, revealing bilateral uveitis.
Imaging: Imaging studies, such as fluorescein angiography (FA) and optical coherence tomography (OCT), can help assess the extent of inflammation and rule out other conditions.
Exclusion of Other Causes: Ruling out other potential causes of uveitis, such as infections or systemic inflammatory diseases.
Timeline of Symptoms
SU typically develops weeks to months after the initial injury or surgery (usually within 2 weeks to 1 year but can occur later).
Symptoms usually begin in the sympathizing eye, even though the exciting eye may still be inflamed.
The timeline varies based on severity and individual response.
Important Considerations
Sympathetic uveitis is a serious condition that can lead to vision loss if left untreated.
Early diagnosis and treatment are crucial to prevent long-term complications.
Long-term monitoring is necessary to manage the disease and prevent relapses.
Individuals with a history of penetrating eye injury or surgery should be vigilant for any signs of uveitis in both eyes.
Enucleation of the exciting eye should be considered in the absence of useful vision.