Vogt-Koyanagi-Harada (VKH) disease is a bilateral granulomatous panuveitis. Which systemic features in the prodromal phase help differentiate VKH from sympathetic ophthalmia?

• A VKH is associated with prior penetrating ocular trauma; sympathetic ophthalmia occurs spontaneously
• B VKH has a meningitic prodrome with headache, meningismus, CSF pleocytosis, plus cutaneous features (alopecia, poliosis, vitiligo); sympathetic ophthalmia follows penetrating/perforating trauma or surgery to the fellow eye ✓
• C VKH exclusively affects Asian populations; sympathetic ophthalmia occurs in all racial groups equally
• D VKH presents unilaterally, while sympathetic ophthalmia is always bilateral from onset

Explanation

VKH is an autoimmune T-cell mediated attack against melanocytes. It has a characteristic meningitic prodrome (headache, nuchal rigidity, tinnitus, dysacusis, CSF pleocytosis) 1–2 weeks before bilateral uveitis, followed by convalescent cutaneous features — poliosis (depigmented lashes/brows), vitiligo, alopecia, and dysacusis (Sunset glow fundus in the convalescent phase). Sympathetic ophthalmia (SO) requires a history of penetrating eye injury or intraocular surgery — it ALWAYS has this predisposing factor. Both are bilateral granulomatous uveitides but differ in etiology and systemic features.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.