Description

William Mackenzie (1830) coined the term sympathetic ophthalmia and is credited with providing the first complete clinical description of the condition. However, physicians and ophthalmologists who lived long before Mackenzie were aware of the condition. The first recorded reference to the disease is perhaps in AD 1000, in the note from Agathias in the anthology compiled from Constantius Cephalis which reads “the right eye when diseased often gives its suffering to the left.” (Anthology, 11, 352, 1000, quoted by Duke Elder S and Perkins ES in System of ophthalmology, volume IX, Diseases of the uveal tract, Henry Kimpton, 1966). Amongst blinding eye diseases it occupies a position way down on the list, with a reported incidence of 0.1% to 0.15% of clinic patients (in the late 19th and early 20th centuries) and between 0.1% to 0.3% of non-surgical ocular trauma (in the late 20th century, see review by Kilmartin DJ in this issue). Why then are we so obsessed with this disease? The answer to this question is best summed up by Edward Jackson in his Editorial for the American Journal of Ophthalmology (5:762, 1922), “.while the fact that it is likely to destroy the sight of the patients useful eye gives the strongest incentive for us to understand and master it.” But “master it” we certainly havent yet, though our understanding of it has undoubtedly improved, running parallel to our understanding of immune mechanisms and workings of the immune system. The review on pathogenesis and management of sympathetic ophthalmia, by Kilmartin DJ, in this issue, is a useful synthesis of the current concepts on the immunology of this condition.

Simultaneously with the realisation of the possible grave consequences of injury to one eye, came the first attempts at managing and preventing the condition. It was long known that suppuration in the injured eye is rarely followed by sympathetic ophthalmia, hence surgeons would intentionally poison an injured eye by introducing suppuration as prophylaxis against sympathetic disease. Early veterinary surgeons had developed a strategy of deliberately destroying the injured eye of horses with lime or a nail, in an attempt to save the other eye. With the advent of steroids and modern immunosuppressants it may seem that we have come a long way. But have we? Or are our poisons only different!

Completed articles should be submitted to Eunice Doyle, Editorial Assistant, CME Journal, Academic Office, B Floor, South Block, Queens Medical Centre Nottingham NG7 2UH