Sympathetic Ophthalmia: How Should We Respond to the Risk?
Sympathetic ophthalmia (SO) is a rare bilateral granulomatous uveitic condition that occurs after an inciting event to one eye, most commonly ocular trauma or intraocular surgery. A study by Hashimoto and colleagues notes that the time from the inciting event to the onset of SO is reported to range from 5 days to 6 months in most cases with about 90% of cases of SO occurring within 1 year. As a corneal and refractive surgeon, although I discuss potential complications of surgery with patients and families including loss of vision and blindness to the eye on which I am operating, I don't typically mention the possibility of complications to the unoperated eye. The one exception is when I am repairing a ruptured globe. And even in those cases, I don't usually discuss SO unless there is severe ocular damage and the chance of visual recovery is very low. The main reason is the rarity of this condition.
@milind The common teaching in ophthalmology is that SO can be prevented if the inciting eye is removed within 10-14 days of the injury. But, as stated above, there are reported cases of SO within 5 days of eye trauma, so the 10-14 day "rule" isn't absolute. As a practical matter, given the extremely low incidence of SO after routine ophthalmic surgery, prophylactic treatment is really only considered in cases of ruptured globes.