Sympathetic ophthalmia typically manifests how long after the inciting ocular injury, and which histopathological finding is pathognomonic?

• A Never before 2 weeks, most commonly between 2 weeks and 3 months; Dalen-Fuchs nodules (aggregates of RPE cells and epithelioid cells between Bruch's membrane and RPE) ✓
• B Within 2 weeks; fibrinous anterior uveitis with hypopyon
• C Within 72 hours; panuveitis with choroidal detachment
• D After 1 year or more; optic disc pallor with cystoid macular edema

Explanation

Sympathetic ophthalmia (SO) is a bilateral granulomatous panuveitis occurring after penetrating ocular injury or intraocular surgery. It almost never occurs before 2 weeks post-injury, with the highest risk period being 4–8 weeks to 3 months, though rare cases occur years later. The pathognomonic histopathological finding is Dalen-Fuchs nodules — discrete collections of epithelioid macrophages and depigmented RPE cells located between Bruch's membrane and the RPE. Treatment is enucleation of the exciting eye before SO develops, or high-dose systemic corticosteroids once SO is established.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.