Sympathetic ophthalmia (sympathetic ophthalmia) is a bilateral granulomatous uveitis following a penetrating injury to one eye or internal eye surgery. The injured eye is called the induced eye, the uninjured eye is called the sympathetic eye, and sympathetic ophthalmia is the general term for it. The etiology is unknown, and its development is now thought to be related to immune factors. In other words, there are two theories: infection and autoimmunity. 1, infection theory: including bacterial infection and viral infection said. After perforating trauma, bacterial infection is transferred from one eye to the other via bloodstream or visual cross cerebrospinal fluid, but the exact pathogen cannot be found. Virus may play an adjuvant role in provoking the immune response. 2. Immunological theory: The penetrating eye injury provides the opportunity for intraocular antigens to reach the local lymph nodes, allowing intraocular tissue antigens to contact the lymphatic system and elicit an autoimmune response. Clinical manifestations The incubation time of sympathetic ophthalmia after trauma is a few hours for the shortest and up to 40 years for the longest, 90% occurring within 1 year, with the most dangerous time being 4 to 8 weeks after injury. In particular, injuries to the ciliary body or wounds within the uveal inlay, or foreign bodies in the eye are more likely to occur. 1, irritated eye: poor wound healing after eye injury, or persistent inflammation after healing, persistent ciliary congestion, along with acute irritation symptoms, edema in the posterior pole of the fundus, optic disc congestion, lambdoid KP behind the cornea, cloudy atrial fluid, and thickened and darkened iris. 2, sympathetic eye: at first there are mild self-conscious symptoms, eye pain, photophobia, lacrimation, blurred vision, gradually obvious irritation symptoms, mild ciliary congestion, cloudy atrial fluid, fine KP, with the development of the disease appearing formative inflammatory reaction, iris texture unclear, pupil narrowing and post-iris adhesion, pupillary margin nodules, pupillary atresia, vitreous clouding, optic papillae congestion, edema. The peripheral choroid can be seen as small yellowish-white foci similar to vitreous warts, which gradually fuse and expand and spread to the entire choroid, leaving pigmentation, pigment depigmentation and pigment disorder in the fundus after the recovery period, and the fundus may appear evening sunset-like “sunset red”. Differential diagnosis 1. For those who have a history of trauma in one eye and irritation in the other eye, we should try to exclude the primary lesion. 2. Exclude crystalline uveitis and uveal cerebritis (VKH): they have something in common that is difficult to distinguish, and each has its own characteristics. 3. Differentiate from Behcet’s syndrome (Behcet’s disease). Diagnosis 1.History of penetrating eye injury, and inflammatory reaction in both eyes. 2.The occurrence of sympathetic ophthalmia can be considered when the sympathetic eye presents with floaters and glitter in the KP anterior chamber and anterior vitreous. 3. The diagnosis can be further confirmed by pathological examination after removal of the irritated eye that has been blinded. Treatment measures 1, the principle of treatment: once diagnosed, promptly dilate the pupil, control inflammation, comprehensive treatment. 2, the first drug to a large number of corticosteroids, daily morning oral o nisone 60 ~ 80mg, later reduced to every other day according to the condition of the situation, after the inflammation subsided should continue to use the maintenance amount for several months, do not just stop using, or reduce its dosage in advance. 3, hormone therapy or can not continue to apply, available immunosuppressants such as Forskolin or cyclophosphamide. 4.Local and systemic application of antibiotics and adjuvant therapy. 5.The irritated eye should be removed early if the vision has been completely lost after early active treatment. If there is a possibility of restoring vision, both eyes should still be actively hitchhiked. 6, generally should be followed up for 3 years or more. During this period, annual follow-up should be done. Preventive measures Firstly, the penetrating wound should be treated correctly so that the tissue embedded in the wound is reset and tightly sutured. To effectively control intraocular inflammation, the intraocular foreign body must be removed. If the wound of the injured eye is large in extent, the content of the eye has been largely dislodged, and the vision has been completely lost without any hope of recovery, the eye should be removed immediately. For the injured eye has been atrophied, eye inflammation continues not to subside, irritation symptoms are obvious and there is no hope of vision recovery, it is appropriate to perform eye removal.