Sympathetic ophthalmia secondary to blunt ocular trauma and treatment with adalimumab

Abstract

Objective: To present the study of a case of sympathetic ophthalmia secondary to blunt ocular trauma.

Case report: A middle-aged male patient attended the ophthalmologic ward of a hospital in the city of La Plata (Buenos Aires, Argentina) with a history of blunt ocular trauma due to a fist blow to the left eye of a few hours of evolution. Visual acuity decreased with ocular hyphema, iridodialysis and hemovitreous; and right eye with no particularities. Topical anti-inflammatory treatment, rest and periodic controls with good control of inflammation were started. After 4 months, the patient returned to the emergency room for pain, red eye and decreased visual acuity in the eye contralateral to the traumatized eye, showing bilateral granulomatous uveitis. Complementary laboratory tests were requested and treatment was started with systemic corticosteroids at immunosuppressive doses and immunomodulation with methotrexate, establishing the presumptive diagnosis of sympathetic ophthalmia. Due to refractory response, it was decided to add treatment with adalimumab, with which the inflammation of both eyes was controlled and the patient recovered the vision of the right eye, although the traumatized eye evolved to ptisis bulbi.

Conclusions: Non-penetrating ocular trauma is a cause of sympathetic ophthalmia. To establish its diagnosis, other causes of bilateral granulomatous panuveitis must be ruled out. Treatment with adalimumab was effective in controlling ocular inflation.