Tiny abnormal cell groupings called granulomas are produced as a result of an uncommon type of uveitis termed sympathetic ophthalmia. This condition develops in the unharmed eye following surgery on the other (harmed) eye or a penetrating injury (such as when a piece of paper, pen, or object punctures the eye). The uveal tract of the uninjured eye gradually becomes inflamed. Uveitis typically appears 3 to 10 weeks following an operation or accident. Very rarely, 30 years or more after the first accident or surgery can pass before sympathetic ophthalmia develops.

 

Introduction:

 

When formerly immune-privileged ocular features become susceptible as a result of damage or surgical procedures, an uncommon disorder known as sympathetic ophthalmia (SO), a bilateral granulomatous uveitis, develops. As a result, inflammation appears on both ends of the affected tissue. The eye that was wounded or had surgery is the aroused eye, and the eye that is sympathetic is the one with compassion that is observing what is taking place on the opposite side. Hippocrates introduced the idea for the first time in the 1500s. A systemic autoimmune etiology was not hypothesized until the 1900s, when a link with non-trauma-related ocular surgery was documented.

Many historical luminaries, particularly Louis Braille, the creator of modern Braille, are thought to have experienced sympathetic ophthalmia. When he was three years old, while playing with a sharp object, his right eye was cut, and by the time he was five years old, he had lost vision in each of his eyes, most likely due to sympathetic ophthalmia.

 

Causes:

 

Concerning the cause of sympathetic ophthalmia, there are still several unanswered questions. Many medical practitioners think that the body’s immune system is failing because it is fighting the healthy uveal tract. The wounded eye is the interesting eye, while the sympathetic eye is the other eye. T cells that infiltrate the uveal tract are assumed to be the main inflammatory mediators. According to studies, the first wave of infiltrative cells consists of CD4+ helper T cells, and the second wave is made up of CD8+ cytotoxic T cells.

In vitro, studies have also revealed proliferative T-cell responses against uveal melanocytes in the peripheral blood of patients with sympathetic ophthalmia. The choroid cartilage is diffusely dilated with lymphocytes, epithelioid cell clusters, and multinucleated giant cells, and the inflammation is frequently granulomatous.

 

Signs and Symptoms:

 

One of the first signs is eye floaters and loss of accommodation. Uveitis, a severe inflammation of the uveal layer of the eye that causes pain and light sensitivity, is a possible stage of the disease. While the inflammatory disease advances into the uvea, where distinctive localized infiltrates in the choroid known as Dalén-Fuchs nodules can be recognized, the affected eye frequently remains relatively painless. However, the retina typically does not become implicated, despite the possibility of perivascular cuffing of the retinal capillaries with inflammatory cells. Sympathetic ophthalmia may be accompanied by secondary glaucoma, vitiligo, and poliosis of the eyelashes, in addition to swelling of the optic disc (papilledema).

Since the individual with the condition will have previous experience with trauma or surgery, whether previously or in the distant past, a complete ocular history is crucial in determining the presence of sympathetic ophthalmia. When history is lacking, physical evidence of earlier trauma can help with the identification of sympathetic ophthalmia.

 

Diagnosis:

 

The clinical diagnosis looks for previous evidence of eye damage. Barring a history of surgical or extensive eye damage, Vogt-Koyanagi-Harada disorder (VKH), which is assumed to have a similar pathophysiology, is an essential differential diagnosis. These patients are believed to have delayed hypersensitivity reactions to skin testing with soluble preparations of human or cow uveal tissue. This is a less-than-specific screening for sympathetic ophthalmia and VKH since antibodies that circulate to uveal antigens have also been discovered in patients with sympathetic ophthalmia, VKH, and chronic uveitis.

 

Homeopathic Treatment for Sympathetic Ophthalmia:

 

Following are some homeopathic medicines that can be useful for slowing the progression of sympathetic ophthalmia:

• Argentum nitricum should be used if there is swelling, yellowish or pus-like release, irritation, and redness of the whites and inside corners of the eyes. The person may have drained and sore eyes that are made worse by light and warmth and improved by refreshing water, cold compresses, and fresh air. Those who require this treatment frequently experience a significant craving to consume salt and sugar.
• Apis mellifica soothes itchy, puffy eyelids that are eased by using cold compresses.
• With unpleasant tears and a clean, non-irritating nasal discharge, Euphrasia officinalis soothes eye inflammation.
• If the eyes are extremely red and inflamed, with searing, smarting, sticking pains, and a persistent itch, Sulphur might be useful. The tears are warm to the touch, and the whites of the eyes appear crimson and bloodshot. Heat makes symptoms worse, and light hurts the eyes. Particularly in the morning, the eyelids may appear constricted.
• Hepar sulphuris calcareum may be recommended when the eyes feel irritated or bruised, with irritation and burning sensations, or when there is a sensation that the eyes are being dragged back into the head. The eyelids may become stuck shut due to yellow discharge, particularly in the morning. Warmth in general and warm compresses help to relieve pain. Extreme sensitivity to light, sound, and cold is a common symptom. The person could be extremely sensitive and irritable.

 

Prevention for Sympathetic Ophthalmia:

 

The only known method of preventing sympathetic ophthalmia, namely removing the injured eye soon after the traumatic occurrence, has been the subject of discussion. Enucleation, or evisceration, aims to keep uveal and retinal tissue from being exposed to the immune system. As evisceration could leave behind remaining uveal tissue, enucleation has traditionally been the preferred therapeutic method. Evisceration, however, probably produces better practical and aesthetically pleasing outcomes and is quicker and easier to carry out. Case studies with successful outcomes are used to prove that evisceration is a feasible alternative.