Ophthalmologists are daily confronted with intraocular inflammation following trauma and/or intraocular surgery. In rare cases, this may lead to the loss of visual function in both eyes, i.e. sympathetic ophthalmia (SO). In order to reduce the scope of responsible action between enucleation of the exciting eye (EE), which still has good vision, and progressive inflammation of the second eye (SE) resulting in blindness if action is delayed, a score system was established based on all SO symptoms which had become known from the literature and personal communications up the end of 1988. The score system developed by HANNE et al. allows causal differentiation between SO or uveitis of other genesis in the partner eye taking into account the prior history and findings in the EE and the occurrence of symptoms after the last accident/operation and findings in the SE. If the last eye is involved, the presence of SO should be assumed in every case where there are signs of intraocular inflammation in order to allow immediate commencement of anti-inflammatory therapy, the more so since it is known that corticosteroids and cytostatics (this also applies to cyclosporin A) can only arrest the immunopathologic processes in the initial phase of the disease.
Between 1979 and 1981 31 children aged from one to 14 years who had been given atropine eye drops to measure refraction presented with the following side-effects: increased temperature (9/31), dry red skin (8/31), reddened eye (3/31) and periorbital dermatitis (2/31) after single (22/31) or repeated (9/31) administration of atropine. In the epicutaneous test with atropine eye drops 1% (readings after 24, 48 and 72 hours) not a single child showed an allergic or toxic reaction. The rarity of an allergy after administration of atropine drops is emphasized by the fact that periorbital dermatitis was observed in only two cases. Clinical experience shows that incipient allergy owing to the anatomical structure of the conjunctiva and eye lids first becomes apparent in the region of the eye, even if the epicutaneous test is not necessarily positive in the dorsum skin. In view of the necessity of administering atropine prior to emergency surgery it is advisable to carry out epicutaneous tests if side-effects have been observed in the eye, to make sure that the patient is not allergic to the drug.
Intraocular inflammation of exogenous origin, which may lead to the loss of visual function in both eyes, i.e. SO confronts ophthalmologists much less rarely than might be expected. Epidemiological studies comprising ergophthalmological aspects underscore this. Questions with regard to therapy should consider the fact that the T cell-mediated cytotoxic disease which causes the transition from the initially unilateral subthreshold exogenous uveitis into the bilateral progressive phase is by no means a rare disorder, especially in secondary surgical operations on predamaged eyes with fresh intraocular hemorrhages, vascular neoplasia and secondary glaucoma. This should be recalled again by practicing ophthalmologists, thus enabling the prevention of SO. If SO is a "forme fruste" of retinitis pigmentosa, as is very likely to be the case, further clarification requires clinicopathologic studies in close collaboration with immunologists.
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