Objective: 
Sympathetic ophthalmia (SO) is a rare bilateral panuveitis that occurs almost inclusively following open globe injury. Incidence rate of SO was 33 per 100,000 person-years, and 90% of the cases occur within 1 year. The pathophysiology of SO is thought to be related to traumatic or surgical disruption of the blood-retinal barrier causing exposed of ocular antigens to the systemic immune system which leads to activation of T-cel mediated reaction against the normal ocular structure of sympathizing eye. Common symptoms of SO include vision loss, pain, floaters, metamorphopsia, and photophobia in the affected eye. 

Material and Methods
We present a 31-year-old man who sustained blunt injury to the right eye during a traffic accident. Lower lid laceration, zygomaticomaxillary complex and orbital floor fracture, and globe rupture was diagnosed initially. Initial management was performed at a nearby medial center including sclera repair and wound debridement with repair. The right eye failed to regain vision. One month later, the patient presented at our out-patient department for management of the zygomaticomaxillary complex and orbital floor fracture.
Open reduction, internal fixation, tarsorrhaphy, and full-thickness skin grafting to the lower eye lid was performed.
However, the patient had a sudden painless decrease of left eye visual acuity (from 1.0 to 0.3) on the post-operative day 3. Emergent consultation of ophthalmologist was arranged. Slit lamp examination disclosed aqueous flare, optic disc hyperemia, and macular edema. Optical coherence tomography(OCT) was performed and disclosed lobulated sub-retinal fluid with bacillary layer detachment.

Results:
Sympathetic ophthalmia was impressed and intravenous pulse therapy of methylprednisolone 1g per day was initiated followed by oral immunosuppressant of Azathioprine(AZA). After medical treatment, visual acuity of the patient improved from 0.3 to 0.7 after 6 months follow-up.

Conclusions: 
This is this first reported patient of sympathetic ophthalmia (SO) in our department over the past 30 years. Although SO is rare, it poses a devastating health concern to the patient due to the possibility of bilateral vision loss. Sufficient explanation before open reduction internal fixation of orbital floor fracture is important when the patient had history of globe rupture. Prophylactic enucleation of the exciting eye is controversial. Steroid pulse therapy and immunosuppressant is the main stay if treatment for SO with fair prognosis if managed timely.