Description

Sympathetic ophthalmia (SO), although rare, is an important disease model for posterior segment intraocular inflammation (PSII) and autoimmune disease because a definite event producing autoantigen sensitisation takes place. The purpose of this article is to review current evidence on SO pathogenesis and management. Recent studies highlight the increasing causative role of surgical trauma, particularly multiple vitrectomy. A large body of evidence, direct and indirect, clinical and experimental, supports an autoimmune aetiology for SO. Precise autoantigen determination is still elusive, but recent precise major histocompatibilty complex restriction, could allow precise autopeptide characterisation through computer modelling, peptide binding assays and lymphocyte stimulation studies, allowing selective non-toxic immunotherapy of PSII via mucosal tolerance. Although enucleation remains controversial, rapid and adequate systemic immunosuppression has greatly improved the visual outcome in sympathetic ophthalmia.