A 30-year-old man who lost his right eye to a perforating injury two months ago now complains of photopsia and blurred vision in the left eye. Examination of the left eye shows vitritis, Dalen-Fuchs nodules at the equator, and thickened choroid on B-scan. The most likely diagnosis is:
- A Vogt-Koyanagi-Harada syndrome
- B Sympathetic ophthalmia ✓
- C Sarcoid choroiditis
- D Birdshot retinochoroidopathy
Correct answer: B. Sympathetic ophthalmia
Explanation
Sympathetic ophthalmia is bilateral granulomatous panuveitis occurring weeks to years, typically 2 weeks to 3 months, after penetrating injury or surgery to one eye. Dalen-Fuchs nodules, vitritis, and choroidal thickening in the fellow eye after trauma are characteristic. VKH produces identical histology but occurs without preceding injury and includes integumentary features like poliosis and vitiligo. Sarcoid and birdshot lack the temporal link to trauma.
Reference: Kanski's Clinical Ophthalmology, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.