This syndrome almost always affects more heavily pigmented persons and is particularly common in people of Asian, Asian Indian, and American Indian descent. Women are affected more than twice as often as men, typically in the 3rd and 4th decades of life. Neurologic symptoms tend to occur early and include tinnitus, dysacusis, vertigo, headache, and meningismus. Cutaneous findings frequently occur later in the disease and include patchy vitiligo, poliosis, and alopecia, often involving the head and neck. Ocular findings include anterior uveitis, vitritis, optic nerve edema, and choroiditis, commonly associated with exudative detachment of the overlying retina.
Treatment includes local and systemic corticosteroids as well as cycloplegics.
Severe or prolonged attacks may require stronger immunosuppressants, such as cyclophosphamide or chlorambucil. Sympathetic ophthalmia is a rare bilateral granulomatous uveitis observed after penetrating trauma or surgery to one eye. However, isolated cases as early as 1 wk or as late as 20 to 30 yr after initial injury have been reported. Symptoms typically include floaters and decreased vision in the sympathizing, noninjured eye. Inflammation may be anterior, intermediate, or posterior, although choroiditis, often with overlying exudative retinal detachment, is common.