Cataract Surgery in Sympathetic Ophthalmia 40 Years After a Perforating Globe Injury with an Initially Retained Intraorbital Metallic Foreign Body: A Case Report and Literature Review

Sympathetic ophthalmia (SO) is a rare bilateral granulomatous uveitis that typically occurs after penetrating ocular trauma or intraocular surgery. We report a 68-year-old man who developed SO in the left eye 40 years after a perforating injury to the right eye with a retained metallic intraorbital foreign body. Before the onset of left-eye symptoms, he underwent a cranial magnetic resonance imaging (MRI) examination. Several months later, he presented with uveitic symptoms and a complicated cataract in the left eye. After excluding other noninfectious and infectious causes of granulomatous uveitis, SO was considered the most likely diagnosis. The exciting eye was subsequently enucleated, with removal of the metallic foreign body. After 1 year of inflammatory quiescence, phacoemulsification with intraocular lens (IOL) implantation was performed, achieving a favorable visual recovery. This case highlights the potential risk of MRI-related migration of retained metallic intraorbital foreign bodies and suggests the feasibility of appropriately timed cataract surgery in quiescent SO.