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Ophthalmology

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A 20 year old man complains of difficulty in reading the newspaper with his right eye, 3 weeks after sustaining a gun shot injury to his left eye. The most likely diagnosis is (LQ)



A Macular edema

B Sympathetic ophthalmia

C Optic nerve avulsion

D Delayed vitreous hemorrhage

Ans. B [Sympathetic ophthalmia] Q

1. Sympathetic ophthalmia - bilateral granulomatous panuveitis, which occurs after penetrating intra ocular Q trauma usually associated with uveal prolapse or less frequently following intraocular surgery

2. 65% cases occur> between 2 weeks and 3 months Qafter initial injury, 90% of all cases occurs within 1st years

Treatment q

1. Prophylaxis I. Early excision of the injured eye. It is the best prophylaxis, when there is no chances of saving vision when there is hope of saving useful vision, following steps should be taken

a. A meticulous repair of the wound

b. Immediate expectant treatment - Topical as well as systemic steroids, antibiotics, atropine

c. When uveitis is not controlled within 2 weeks of expectant treatment - eye should be excised immediately

2. Treatment when sympathetic ophthalmitis has already supervened

a. If the case is seen shortly after the onset of inflammation (i.e. during prodromal stage) in the sympathinging eye, and the injured eye has no useful vision, this useless eye should be excised at once.

b. Conservative treatment of sympathetic ophthalmitis

i. Corticosteroids, Q ii. IV ACTH Q

iii. Immunosuppressant drugs Q iv. Topical atropine Q

3. The treatment should be continued for a long time.

4. Prognosis Q - Diagnosed early (during prodromal stage) and immediate treatment with steroids, vision may be obtained

5. Advanced cases - prognosis is very poor

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