The role of perivascular melanophage infiltrates in the conjunctiva in sympathetic ophthalmia

Purpose: To report pathologic changes in the conjunctiva from the exciting eye in a case of sympathetic ophthalmia (SO). Methods: Report of clinical findings and conjunctival histopathology in a patient with SO. Results: A 50-year-old male developed SO, with unusual peribulbar conjunctival pigmentation in the inciting eye. Histological examination of the conjunctival biopsy revealed perivascular distribution of CD68⁺ melanophages that also expressed HLA-DR, suggesting that these macrophages may act as antigen-presenting cells. In addition, increased CD4⁺ and CD3 ⁺ lymphocytes were noted in the subconjunctival space when compared to specimens of normal conjunctiva and traumatic uveal prolapse without SO, suggesting T-cell recruitment. Conclusions: These pathologic findings suggest a possible mechanism by which local antigen processing by subconjunctival melanophages may play a role in the initiation of the complex cell-mediated response seen in SO.