Sympathetic ophthalmia within the limit of the radical surgical recommendation - forensic implications

Sympathetic ophthalmia is a bilateral diffuse granulomatous inflammation of the surgical or non-surgical eye trauma that occur as a rare and severe complication of the trauma (1:14,000). The injured eye becomes the excitatory eye that initiates the inflamatory state of the non-injured eye that becomes the sympathetic eye. The conservative therapeutic approach, i.e. the medical treatment (steroid and non steroidal anti-inflammatory therapy and immunomodulatory therapy) is recognized as the first choice compared to the radical treatment which is injured eye evixceration. However, the professional experience and the clinic evolution may play an important role. Clinical practice brings cases at the border of radical and conservative treatment with complex ethical and legal implications that are discussed. We present two cases which received a medical approach in one case and a surgical approach in other case. Based on our experience we consider that the only true prophylaxis for the loss of a healthy eye is the enucleation of the traumatized eye at the very first symptoms: many ophtalmologists share our vision. Evisceration also, in selected cases, is an acceptable alternative. We discuss also about malpraxis and liability issues of such a professional reccomendation as much as ethical issues such as beneficence and non-maleficence which seems to be contradictory if we considered one eye vision or both eye vision as the best outcome.