Contributor: Fahmeeda Murtaza (CC3)
Patient Presentation: A 50-year old male presented to the ophthalmology service with a 1-day history of vision loss in his left eye. He also endorsed a 1-week history of headaches, fatigue, tinnitus, and malaise. His past ocular history included a globe rupture in his right eye 20 years ago from penetrating trauma, as well as a second globe rupture in the same right eye 1 month prior to presentation from a blunt injury at work. Following both globe ruptures, the right eye was successfully closed with primary intention, but was left with NLP vision. His past medial history was remarkable for diabetes and hypertension.
On examination, visual acuity was 20/400 OS, IOP was 14, and his left pupil was reactive to light. There were 1+ AC cells, 1+ flare, and 1+ vitreous cells. A fundus photo and late-phase IVFA image of the left eye are shown below:
Question 1: Describe the findings in the fundus photo and IVFA image.
An OCT macula of the left eye is below:
Question 2: What is the key OCT finding?
Question 3: What is the diagnosis?
Question 4: What is the initial treatment for this patient?
The patient was admitted and treated with 1g intravenous solumedrol for 3 days and had a full uveitic work-up, which returned normal. He was then transitioned to oral prednisone 1mg/kg for 7 days, then tapered by 10mg every week.
At the 2-week follow-up, OCT imaging (above) showed resolution of subretinal fluid. His vision improved to 20/50 and was continued on a tapering dose. Azathioprine was also initiated as a steroid sparing therapy.
Recognize the clinical, fundoscopic, and OCT features of sympathetic ophthalmia.
Understand the treatment and management of sympathetic ophthalmia.