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.
Treatment requires long-term corticosteroids and immunosuppressive drugs.
Prophylactic enucleation of a severely injured, blind eye should be considered within 2 wk of loss of vision to prevent damage to the other eye. Ocular sarcoidosis has varied presentations. Symptoms and signs of anterior, intermediate, and posterior uveitis occur. In the absence of a diagnostic biopsy from a granuloma identified clinically, the diagnosis remains presumptive. So-called blind lacrimal or conjunctival biopsies of clinically normal tissue should be discouraged, since the yield is exceedingly low.