Four patients with sympathetic ophthalmia (SO) simulating Vogt-Koyanagi-Harada disease (VKH) were studied. They all had penetrating wounds of the globe and developed bilateral uveitis, as well as two or more extraocular manifestations, e.g., vitiligo, poliosis, dysacousia and/or meningitis. Histopathologically, the enucleated globes revealed features that were identical to those observed in Harada's disease: mainly, a granulomatous choroiditis with formations of chorioretinal adhesions and migration of pigment into the disorganized retina. The study indicated that the only reliable feature that could differentiate SO from VHK disease was the history of a penetrating wound in the former and the absence of such trauma in the latter.