Rare Case of Severe Sympathetic Ophthalmia Strikes Without Warning: A report

These findings of the case report are published in the Journal of Clinical Ophthalmology and Research in April, 2026, by Dr. Itzar Chaidir Islam and affiliated researchers from Hasanuddin University.

The unusual manifestation is tremendously significant for contemporary clinical practice because pediatric SO predictably follows an aggressive disease trajectory, carrying greatly elevated risks for devastating structural complications such as iris bombe and secondary angle-closure glaucoma. Identifying this sight-threatening disease early remains absolutely vital for treating physicians, as deploying prompt, multidisciplinary therapeutic intervention represents the only definitive mechanism to effectively preserve ocular architecture and circumvent irreversible childhood blindness.

An eight-year-old boy presented with severe bilateral vision loss six months following a penetrating metallic injury to his right eye; subsequent ultrasound investigations revealed distinct choroidal thickening without posterior visualization, directly leading to a clinical diagnosis of probable SO. The medical team immediately administered systemic corticosteroids and performed complex reconstructive intraocular surgeries across both eyes, successfully stabilizing the intraocular pressure and controlling the severe inflammation despite ultimately experiencing limited visual acuity recovery.

Pathophysiologically, the physical occurrence of penetrating ocular trauma critically breaches the natural blood-ocular barrier, directly exposing previously hidden uveal and retinal self-antigens to the body's systemic immune network. This unexpected molecular exposure subsequently sensitizes key antigen-presenting cells, which immediately provoke a robust, T-cell-mediated autoimmune cascade that clinically manifests as diffuse bilateral granulomatous inflammation spreading relentlessly throughout the uveal tract.

For ophthalmic practitioners, the distinctive case heavily underscores the critical necessity to constantly maintain high clinical suspicion for SO in pediatric patients presenting with bilateral inflammation after trauma, even when typical posterior segment findings remain obscured. The core insight fundamentally informs future patient care by vividly demonstrating that individualized, aggressive immunosuppressive regimens paired with expertly timed surgical reconstruction must be strategically deployed to successfully halt progressive structural deterioration.

Reference

Islam IC, Rahmah MN, Eka H. Diagnostic and surgical challenges of pediatric sympathetic ophthalmia without posterior segment visibility. J Clin Ophthalmol Res 2026;14:226-31.