Mechanism of sympathetic inflammatory eye disease

Sympathetic eye inflammation is an inflammation of the entire membrane surrounding the eyeball, also known as the uvea. This membrane contains many blood vessels that nourish the eyeball. When the uvea is damaged, the body makes its own antibodies, which combine with the antigens caused by the damaged uvea to form a complex, causing damage to blood vessels by chemical mediators released.
Thus, the mechanism of sympathetic inflammatory eye disease is a specific type of immune response, also known as a hypersensitivity reaction. This also occurs in unaffected eyes.
Causes of sympathetic inflammation include:
Trauma to the eyeball with damage to the uvea such as: Severe contusion, sclera, penetrating trauma to the eyeball with or without direct association with the uvea, ulcers corneal perforation. Surgery at the eyeball: Trabeectomy, iris entrapment, laser blepharoplasty, cryosurgery, vitreous surgery to place artificial vitreous, especially with iris stuck in the incision. In addition, there are some cases of patients with homozygous inflammation without an identifiable cause.

First of all, when there is an injury to the eyeball, it should be treated by suturing the eyeball. In cases of severe trauma, eyeball removal may be necessary to reduce the risk of sympathetic ophthalmia. Complications after surgery also need to be properly managed. The duration of sympathetic inflammation can range from 10 days to 50 years, with an average of 4 to 8 weeks after trauma.
The treatment principle of empathic inflammation is:
Combination of local and systemic treatment, with priority given to local treatment. Active corticosteroid treatment, combination of antibiotics, immunomodulatory drugs,... Closely monitor patients during and after treatment. 2.1 Specific treatment Local treatment with wound treatment when there is tissue jam or not closed. Drugs are antibiotics, corticosteroids and atropine. Systemic treatment with antibiotics, vasodilators and corticosteroids.
2.2 Medical treatment Corticosteroid therapy In the past, when corticosteroids were not used, the prognosis for eyes with sympathetic ocular inflammation was very poor, with 70% of cases being permanently blind. Currently, high-dose corticosteroids are indicated when starting, without reducing the dose of corticosteroids or stopping abruptly.
Only gradually reduce the dose over 6 months when the inflammatory process is completely resolved. In adults, the oral dose of prednisolone is 1 to 2 mg/kg body weight/day for the first week, then tapered off when the inflammatory response is controlled to a maintenance dose of 5 to 10 mg/day.
Systemic corticosteroid therapy must closely monitor blood pressure and blood sugar. Infection should also be ruled out prior to corticosteroid therapy.

Immunosuppressive drugs Use immunosuppressive drugs in case patients do not respond to corticosteroid therapy or use in combination with corticosteroids to prevent complications. Before use, it is necessary to check liver and kidney function.
Anti-metabolism group This group of drugs helps prevent cell growth and division. The drug has many side effects and can cause dangerous complications, so it should not be used in children, before using, it is necessary to fully consider potential complications. Treatment with an anti-metabolite group should be closely monitored by an experienced internist.
Inhibitors of T lymphocytes (cyclosporin A) Because eyes with sympathetic inflammation are often densely infiltrated by activated T lymphocytes, cyclosporin A is a good inhibitor for treatment.
The dose of cyclosporin A 3 - 5 mg/kg/day can be combined with prednisolone 15 - 20 mg/day. The effectiveness of treatment with cyclosporin A often disappears when the drug is stopped, so a long course of treatment may be required for some patients.
Cyclosporin A can cause nephrotoxicity and hypertension.

Empathic inflammation is a serious eye disease that can cause permanent blindness even with aggressive treatment. However, with early diagnosis, prompt, appropriate and aggressive treatment, patients can maintain useful vision. Some cases of sympathetic inflammation can cause complications of cataracts, glaucoma, atrophy of the eyeballs,...
Experts advise patients when seeing suspicious symptoms of the disease, they need to quickly go to the doctor's office. specialist doctors. Only a specialist can diagnose the disease quickly and accurately, thereby providing timely treatment to save vision.
To prevent sympathitis, if the injured eye has completely lost function and there is an indication to remove the eye, the patient should comply. In addition, it is also necessary to have regular check-ups 3 to 6 months after the disease to check for recurrence of the disease.
In addition, everyone should pay attention to safety, limit eye injury. For adults, labor protection must be well implemented. Children are often injured by activities, playing violent games, guns, darts, etc., so parents need to pay attention.
Vinmec International General Hospital with a system of modern facilities, medical equipment and a team of experts and doctors with many years of experience in medical examination and treatment, patients can rest assured to visit. examination and treatment at the Hospital.
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