Penetrating trauma associated with findings of multiple evanescent white dot syndrome in the second eye: coincidence or an atypical case of sympathetic ophthalmia?
OBJECTIVE
To report a case of sympathetic ophthalmia (SO) resembling multiple evanescent white dot syndrome (MEWDS).


METHODS
Retrospective chart review.


RESULTS
A 17-year-old girl with a ruptured globe in the right eye underwent prompt primary repair and vitrectomy, scleral buckling, and silicone oil infusion 3 weeks later. Eight weeks after injury, she presented with visual loss in the left eye. Fundus examination in the left eye disclosed optic disk swelling and well-circumscribed, 100 to 500 microm diameter gray-white lesions at the level of the retinal pigment epithelium (RPE) posterior to the equator, sparing the fovea. On fluorescein angiography, the lesions appeared as areas of blocked choroidal fluorescence in the arterial phase and were associated with dye leakage in a wreathlike pattern during venous filling. Dye leakage occurred at the optic disk. Visual field testing showed depressed central sensitivity and an enlarged blind spot in the left eye. The patient was treated with prednisone and underwent diagnostic enucleation of the right eye. Histopathology showed rare choroidal granulomata and pigment phagocytosis. Vision improved to 20/20 in the left eye, and the window defects persisted. Visual field testing 6 months later was normal. One month after discontinuing prednisone, new areas of RPE hypopigmentation developed. Two weeks later, choroidal inflammation recurred and periphlebitis developed.


CONCLUSIONS
This case indicates that SO can mimic MEWDS.
Institute of Ophthalmology and Visual Science, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ 07101, USA.
Michael
M
Landolfi
Neel
N
Bhagat
Paul
P
Langer
Ronald
R
Rescigno
Neena
N
Mirani
J Donald M
JD
Gass
Ruben A
RA
Grigorian
Marco A
MA
Zarbin
D000063:Accidents, Traffic; D000293:Adolescent; D003937:Diagnosis, Differential; D015353:Eye Enucleation; D005129:Eye Foreign Bodies / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D015807:Eye Injuries, Penetrating / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D009879:Ophthalmia, Sympathetic / Q000175:diagnosis*; D012160:Retina / Q000293:injuries*; D012164:Retinal Diseases / Q000175:diagnosis*; D012421:Rupture; D012591:Scleral Buckling; D012827:Silicone Oils / Q000627:therapeutic use; D013577:Syndrome; D058609:Visual Field Tests; D014794:Visual Fields; D014821:Vitrectomy
D012827:Silicone Oils