Traumatic Injury in One Eye Followed by a Hyperopic Shift in the Other: Are They Related?

Jessica Lee, MD; Jerome V. Giovinazzo, MD; Steve A. Agemy, MD; Ronald C. Gentile, MD

Disclosures

September 06, 2016

Case Diagnosis

The history of a traumatic open-globe injury in the right eye and findings on examination of the left eye of granulomatous uveitis, vitritis, and Dalen-Fuchs nodules that leaked on fluorescein angiography with the presence of subretinal fluid support the diagnosis of sympathetic ophthalmia (SO).

The differential diagnosis of SO includes ocular diseases that can present as granulomatous panuveitis.

Vogt–Koyanagi–Harada syndrome (VKH) can be difficult to differentiate from SO, although patients with VKH usually have no history of surgery or trauma. Patients with VKH present with bilateral granulomatous uveitis and bilateral serous retinal detachments. Even though VKH can occur in white patients, it is more prevalent in Asian, Middle Eastern, Native American, and Hispanic patients. VKH patients can also present with skin and hair changes, such as vitiligo and alopecia, and neurologic symptoms, including mental status changes, headaches, and tinnitus, none of which were seen in our patient.

Syphilis and sarcoidosis can present with granulomatous uveitis, choroiditis, and vitritis, but typically present with other constitutional symptoms and can be excluded with a comprehensive systemic workup. In our case, the history of trauma in the fellow eye and the negative review of systems make a diagnosis of syphilis and sarcoidosis unlikely.

Clinical Course

The patient eye examination and SO partially improved with 80 mg of oral prednisone , which was switched to intravenous methylprednisolone 250 mg four times a day . A total uveitis workup, including a chest x-ray, was negative. A steroid-sparing agent, mycophenolate mofetil, was used as the steroid was tapered. The hyperopic shift resolved with resolution of the subretinal fluid and improvement in visual acuity to 20/25 in the left eye without correction.

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