Unusual case reveals how even a blind eye can trigger dangerous inflammation in diabetic patient

A rare immune eye condition in a woman with longstanding diabetes highlights the potential for inflammation from non-functional eyes to threaten remaining sight, offering new insights into managing complex ocular diseases.

A rare immune eye disease in a woman with long-standing, poorly controlled type 1 diabetes has offered an unusual clinical lesson: even a blind eye can trigger inflammation that threatens the only eye still able to see. According to a case report from ophthalmologists led by the King Khaled Eye Specialist Hospital and Research Centre in Riyadh, the woman developed sympathetic ophthalmia after a glass injury and surgical repair to an eye that had already lost vision years earlier, then later faced diabetic retinal disease complicated by pregnancy.

Sympathetic ophthalmia is an uncommon bilateral inflammation that can follow penetrating eye injury or surgery. StatPearls says it is thought to be an autoimmune response against uveal tissue, the pigmented middle layer of the eye, and estimates the condition occurs in roughly 0.2% to 0.5% of penetrating eye wounds and about 0.1% of intraocular operations. A separate case report in the National Library of Medicine showed the disease can appear very quickly, with symptoms emerging just five days after injury, well before the more familiar two-week window.

In this patient’s case, the injured right eye had already been blind and later became shrunken and non-functional, but clinicians still considered the trauma and repair to be the trigger. Her left eye, which had been her only seeing eye, developed inflammation, blurred vision and signs of worsening proliferative diabetic retinopathy, including new blood vessel growth and a retinal detachment. She was treated with high-dose intravenous steroids, then adalimumab, a tumour necrosis factor inhibitor used to reduce steroid exposure in non-infectious uveitis.

The response was notable: once the inflammation came under control, the abnormal retinal vessels partially regressed even before further laser treatment or anti-VEGF injections. Later, a pregnancy complicated the picture, with recurrent bleeding and tractional membranes threatening the macula. The team continued adalimumab after multidisciplinary discussion, avoided anti-VEGF injections during pregnancy and delayed surgery until after delivery, when she underwent vitrectomy with membrane peeling, endolaser and gas tamponade. At follow-up, her retina was attached, inflammation was quiet and vision had improved, though cataract still limited recovery. The authors said the case suggests that severe inflammation can worsen diabetic eye disease and that treating the inflammatory component may ease the retinal damage as well.