Severe bilateral vision loss due to a unilateral penetrating injury by sympathetic ophthalmitis.

April 2011, Vol. 101, No. 4 SAMJ The patient sustained an accidental injury that resulted in broken glass causing a penetrating eye injury in her left eye. A corneal laceration with iris prolapse was not identified at a secondary hospital. Eight weeks after the injury, she presented at Groote Schuur Hospital complaining of decreased vision and severe pain in both eyes. The diagnosis was sympathetic ophthalmitis after all infective and inflammatory causes were excluded. Her visual acuities were counting fingers at 30 cm with her left eye and 6/60 in her right eye. On cursory examination, the left eye seemed normal (Fig. 1) but a corneal scar with prolapsing intra-ocular tissue was visible on elevating the upper lid (Fig. 2). She was treated with systemic immunosuppression (intravenous methylprednisolone) and topical corticosteroids. The prolapsed iris was excised and the corneal laceration repaired. Vision in the left eye did not improve but improved to 6/36 in the right eye.