Sympathetic ophthalmia caused by a severe ocular chemical burn: a case report and literature review

We herein presented a case of sympathetic ophthalmia induced by chemical burns. A 39-year-old male was referred to our retinal clinic complaining of sharply decreased vision in his right eye, with photophobia and headache. He had suffered severe chemical burns five months ago, and his left eye underwent amniotic membrane transplantation combined with tarsorrhaphy for persistent corneal ulceration. A comprehensive examination was performed. After excluding other infectious ocular diseases and systemic inflammatory disease, Vogt-Koyanagi-Harada was considered. A regimen of 1.5 mg/kg prednisone per day was initiated, and tapered to a weekly dose. The inflammation in the patient’s right eye was improved, and the best-corrected visual acuity recovered to 20/50. He continued to be seen by his corneal specialist for follow-up on the left eye. A regular B-scan was performed, and atrophy of the left eyeball was detected 2 months later. Upon removal of the left eyelid sutures, corneal perforation with a prolapsed iris was found. Afterwards, the inflammation of the right eye reoccurred, and the diagnosis was revised to sympathetic ophthalmia. The patient underwent an enucleation procedure on the left eye, and a massive prednisolone regimen was initiated, and then tapered slowly over one year. Pathological results showed diffuse epithelioid cells, polymorphonuclear giant cells, and lymphocyte infiltration in the uveal tissue. Sympathetic ophthalmia was confirmed. The right eye remained unremarkable at 41 months of follow-up. An uncommon case is presented of sympathetic ophthalmia following severe chemical burns. It is notable that sympathetic ophthalmia developed after chemical burns to the ocular surface and corneal perforation, despite reconstructive treatment combined with tarsorrhaphy.