Exceptionally delayed sympathetic ophthalmia diagnosed by multimodal imaging: A 36-year latency case report

Sympathetic ophthalmia (SO) is a rare bilateral granulomatous uveitis that typically appears weeks to months after penetrating ocular trauma; presentations decades later are exceptional. A 40-year-old man developed blurred vision in his left eye thirty-six years after childhood penetrating ocular trauma to the right eye. Best-corrected visual acuity was no light perception in the right eye and counting fingers at two meters in the left eye. Multimodal imaging revealed diffuse choroidal thickening as well as subfoveal serous detachment. Laboratory work-up excluded infectious and malignant etiologies. High-dose intravenous methylprednisolone, followed by oral prednisone and azathioprine, led to the resolution of subretinal fluid and improvement to 20/20 at 6 months, sustained over 18 months. This case underscores the lifelong risk of SO after ocular injury and illustrates the diagnostic value of multimodal imaging in detecting choroidal inflammation, guiding treatment response monitoring, and long-term management.

Keywords: Sympathetic ophthalmia, optical coherence tomography, multimodal imaging, uveitis, ocular trauma.