Sympathetic ophthalmia manifesting with conjunctival chemosis

A 13-year-old girl was referred to us with the complaints of severe headache and decreased visual acuity (VA) in the right eye, of 1 week duration. She had a history of penetrating ocular trauma in the left eye 1 month earlier. Her best-corrected VA was counting fingers in the right eye and no light perception in the left eye. External examination revealed a massive inferior conjunctival chemosis bilaterally (Fig. 1a). Slitlamp examination of the right eye showed 0.5? cells, no corneal precipitates, and mild vitritis. There were a cloud cornea and an iris distortion, and no posterior segment structures were visible in the traumatized eye. Fundus examination of the right eye revealed focal yellow–white lesions at the level of the retinal pigment epithelium (RPE), multifocal serous retinal detachment (SRD), and hyperemic optic disc (Fig. 1b). Fluorescein angiography showed multifocal leaks at the level of the RPE with pooling of dye in the area of SRD (Fig. 1c). Ultrasonography of the right eye showed marked, diffuse choroidal thickening (3 mm), and diffuse retroscleral edema with T-sign in the peripapillary region (Fig. 1d). In the traumatized eye, there was choroidal and ciliary body detachment. Optical coherence tomography of the right eye showed SRD with subretinal septa. A diagnosis of SO was made, and the patient was treated with intravenous methylprednisolone (1 g/day for 3 consecutive days) followed by oral administration of prednisone (1.5 mg/kg). Three days after presentation, intraocular inflammation had improved and conjunctival chemosis had completely resolved. One week later, the chemosis had recurred and the SRD became more extensive and bullous. Cyclosporin (5 mg/kg/day) and then infliximab (5 mg/kg/ 0–2–4–8 weeks) were added. After a follow-up of 3 months, conjunctival chemosis had disappeared (Fig. 2a) and VA was 20/200. SRD had resolved, and there were subretinal fibrosis with RPE proliferation (Fig. 2b). Ultrasonography showed resolution of choroidal thickening and retroscleral edema (Fig. 2c). S. Attia S. Jenzeri I. Chtioui B. Jelliti S. Zaouali S. B. Yahia M. Khairallah (&) Department of Ophthalmology, Fattouma Bourguiba University Hospital, 5019 Monastir, Tunisia e-mail: moncef.khairallah@rns.tn