A 20-year-old man sustained a full-thickness corneoscleral laceration from a road traffic accident. Three weeks after primary repair he develops photophobia, pain, and blurred vision in BOTH eyes. Examination shows bilateral granulomatous anterior uveitis, vitritis, and yellow-white lesions at the level of the retinal pigment epithelium. The most likely diagnosis is:

• A Sympathetic ophthalmia ✓
• B Vogt-Koyanagi-Harada syndrome
• C Sarcoidosis-related panuveitis
• D Lens-induced granulomatous uveitis

Explanation

Sympathetic ophthalmia is a bilateral granulomatous panuveitis following penetrating ocular injury or intraocular surgery, with a latent period typically ranging from two weeks to several years. Dalen-Fuchs nodules, the yellow-white RPE-level lesions described here, support the diagnosis. VKH produces a similar picture but lacks the inciting trauma history, which is the discriminating feature. High-dose systemic corticosteroids with immunosuppression are the mainstay of treatment.

Reference: Kanski's Clinical Ophthalmology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.