Diagnostic and surgical challenges of pediatric sympathetic ophthalmia without posterior segment visibility

Abstract

Sympathetic ophthalmia (SO) is a rare bilateral granulomatous uveitis occurring after ocular trauma or intraocular surgery. Pediatric case has special diagnostic challenges due to limited cooperation and overlapping presentations with other inflammatory disorders. An 8-year-old boy presented with progressive bilateral visual impairment 6 months after sustaining a penetrating corneoscleral injury to the right eye caused by a metallic object. At the initial presentation, the right eye showed corneal edema with sutures from the previous corneal repair. The previously uninjured left eye also demonstrated active inflammatory changes. Both eyes showed severe anterior segment inflammation characterized by iris bombe, irregular pupil, pupillary membrane formation, lens opacity, and choroidal thickening consistent with bilateral panuveitis. Based on the history of penetrating trauma, the latent period, and the presence of bilateral granulomatous uveitis, a clinical diagnosis of SO was established. Initial management consisted of topical and systemic corticosteroids, followed by surgical intervention, including corneal wound revision with anterior chamber washout in the right eye and synechiolysis, anterior chamber irrigation–aspiration, posterior capsulotomy, anterior vitrectomy, and foldable intraocular lens implantation in the left eye. Postoperatively, visual acuity did not improve significantly, but the intraocular inflammation and other clinical symptoms were successfully controlled. SO is a case that could occur after penetrating ocular trauma or intraocular surgery. In pediatric patients, the disease often follows a more aggressive pattern with rapid progression and a higher risk of complications. Therefore, early recognition, prompt systemic immunosuppression, and timely surgical intervention remain essential to preserve ocular structure and prevent further deterioration. This case emphasized that every child presenting with bilateral intraocular inflammation after ocular trauma should be promptly evaluated for SO to avoid irreversible vision loss through early multidisciplinary intervention and long-term follow-up.

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