1 / 21

Sympathetic Ophthalmitis

Sympathetic Ophthalmitis. Annie Mathai, Rajeev K Reddy, Hemant S Trehan, Ritesh Narula Smt.Kanuri Santhamma Retina Vitreous Centre, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad. Ocular History. 48 year old man

ccorman
Download Presentation

Sympathetic Ophthalmitis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Sympathetic Ophthalmitis Annie Mathai, Rajeev K Reddy, Hemant S Trehan, Ritesh Narula Smt.Kanuri Santhamma Retina Vitreous Centre, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad

  2. Ocular History • 48 year old man • 7-2007: decreased vision OS following injury with stone 17 days earlier • Diagnosed as globe rupture with uveal prolapse • Underwent excision of prolapsed uveal tissue and corneo-scleral tear repair

  3. 28th July 2007: First Presentation • VA: OD - 20/20, OS - no PL • OD - normal • OS - red eye • Corneo-scleral sutures • Irregular AC • AC details not clear • Soft eye • No fundus view OS

  4. Ultrasonography OS • Funnel RD • Choroidal thickening • Peripheral choroidal detachment

  5. Diagnosis & management • OD - normal • OS - status post corneo-scleral tear repair, RD, pre-phthisical eye • Treatment OS: • Prednisolone acetate eye drops 2 hourly • Ofloxacin eye drops 4 hourly • Atropine eye drops 3times/day

  6. 9th September 2007: Second Presentation • Pain, redness, decreased vision OD x 3 days • Seen elsewhere with shallow AC, raised IOP • Diagnosed as angle closure glaucoma OD • Underwent OD:YAG peripheral iridectomy • Started on topical and systemic steroids (20mg)

  7. 9th September 2007: Second Presentation • VA: OD - 2/60, OS - no PL • Anterior segment OD • AC: 1-2+ cells, 1+ flare • Sluggishly reacting pupil • 3 attempted PIs • IOP - 10 mm Hg • OS findings same as before

  8. 9th September 2007: Second Presentation • Fundus examination OD • No vitreous cells • Shallow serous detachment at macula • Diagnosed as CSCR

  9. 9th September 2007: B-scan & OCT • Localised RD on B-scan & OCT • No choroidal thickening on B-scan

  10. 9th September 2007: Diagnosis • Acute central serous chorioretinopathy precipitated by steroids • Anterior uveitis secondary to PI • Systemic steroids discontinued • Topical steroids continued • Called for review after 3 days

  11. 12th September 2007: 3 days later • Visual acuity OD - 6/18 • AC - 2+ cells, 1+ flare • No vitreous cells • Fundus - shallow serous RD • Topical steroids continued • Called for review after 2 weeks

  12. 19th September 2007: 1 week later • Seen in emergency • Sudden decrease of vision OD • Visual acuity - 1/60 • Fresh kps, 2+ cells, 2+ flare • Fundus - serous RD • Yellow subretinal lesions

  13. Clinical diagnosis • Symathetic ophthalmitis • B-scan to look for choroidal thickness • Fluorescein angiography

  14. Ultrasonography • Echo free vitreous cavity • Localised shallow RD • No choroidal thickening

  15. Fluorescein angiography 27 sec 1min 9 sec 2 min 10 sec 4 min 40 sec

  16. Fluorescein angiography • Pin-point hyperfluorescence • Hyperfluorescence increases in late phase

  17. Final diagnosis & management • Sympathetic ophthalmitis • IV Methyl prednisolone 1 gm daily x 3 days • Followed by oral prednisolone • OU: Pred acetate eye drops 2 hourly • OU: Homatropine eye drops 3 times/day

  18. Response to treatment (OD) • On 4th day visual acuity improved to 6/18 • In 10 days visual acuity was 6/6 • Serous RD completely resolved • Topical and oral steroids continued • Also started on Azothioprine 50 mg BD

  19. Response to treatment - serous RD Prior to treatment Following treatment

  20. Last follow-up Visual acuity - 6/6

  21. Conclusions • Bilateral ocular involvement following open-globe injuries .......... • High alert for sympathetic ophthalmitis • Fluorescein angiography is a crucial investigation to confirm sympathetic ophthalmitis

More Related