Objective: To assess the incidence and risk factors for sympathetic ophthalmia (SO) following open globe injuries (OGIs) and to evaluate the protective effect of early eye removal surgeries (enucleation and evisceration).
Design: Retrospective clinical cohort study.
Subjects: Patients diagnosed with OGIs between September 2004 and September 2024.
Methods: This study utilized de-identified data from the TriNetX network. Incidence rates of SO were calculated at 6 months, 1 year, 5 years, and 10 years postinjury. Risk factors for SO, including demographics and the impact of enucleation or evisceration performed within 30 days of injury, were analyzed using Cox proportional hazard models.
Main outcome measures: Incidence rates of SO at 6 months, 1 year, 5 years, and 10 years postinjury.
Results: Of 63,763 patients with OGIs (mean age 42.0 ± 23.7 years; 70.9% male), the overall incidence of SO was 0.13% (1 in 768) at 6 months, rising to 0.18% (1 in 555) at 10 years. SO was diagnosed in 105 patients, with 74.3% presenting within 6 months of injury. Enucleation was performed in 1.82% of patients with OGIs at 6 months, increasing to 2.15% by 10 years. Although early eye removal (within 30 days) was associated with a lower hazard (hazard ratio (HR) 0.655), this finding was not statistically significant (95% CI: 0.236-1.817; P = .416). Demographic factors associated with increased SO risk included Native Hawaiian or other Pacific Islander ethnicity (HR: 6.775, 95% CI: 1.786-25.694, P = .005) and Hispanic ethnicity (HR: 2.862, 95% CI: 1.077-7.608, P = .035).
Conclusions: SO following OGIs is rare but remains a long-term risk, with most cases presenting within the first year after injury. Early eye removal surgery (within 30 days) was not significantly associated with a lower risk of SO. Additionally, individuals of Native Hawaiian or Other Pacific Islander and Hispanic ethnicities are at increased risk for SO, warranting targeted follow-up in these populations.
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