A 20-year-old man complains of difficulty in reading the newspaper with his right eye, three weeks after sustaining a gun shot injury to his left eye. The most likely diagnosis is

SYMPATHETIC OPHTHALMITIS Sympathetic ophthalmitis is a serious bilateral granulomatous panuveitis which follows a penetrating ocular trauma. Etiology : Predisposing factors: 1. It almost always follows a penetrating wound. 2. Wounds in the ciliary region (the so-called dangerous zone) are more prone to it. 3. Wounds with incarceration of the iris, ciliary body or lens capsule are more vulnerable. 4. It is more common in children than in adults. 5. It does not occur when actual suppuration develops in the injured eye. Clinical picture: I. Exciting (injured) eye: It shows clinical features of persistent low grade plastic uveitis, which include ciliary congestion, lacrimation and tenderness. Keratic precipitates may be present at the back of cornea (dangerous sign). II. Sympathizing (sound) eye: It is usually involved after 4-8 weeks of injury in the other eye. Earliest repoed case is after 9 days of injury. Sympathetic ophthalmitis, almost always, manifests as acute plastic iridocyclitis. Clinical picture of the iridocyclitis in sympathizing eye can be divided into two stages: 1. Prodromal stage: Symptoms: sensitivity to light (photophobia) and transient indistinctness of near objects (due to weakening of accommodation) are the earliest symptoms. Signs: In this stage the first sign may be presence of retrolental flare and cells or the presence of a few keratic precipitates (KPs) on back of cornea. Other signs includes mild ciliary congestion, slight tenderness of the globe, fine vitreous haze and disc oedema which is seen occasionally. 2. Fully-developed stage: It is clinically characterised by typical signs and symptoms consistent with acute plastic iridocyclitis. Ref:- A K KHURANA; pg num:-413