Sarcoidosis

  • Idiopathic granulomatous inflammation of many organs
  • Most common ophthalmic manifestation: uveitis
  • Photophobia, eye pain, although many patients have no ophthalmic symptoms because inflammation is indolent
  • Cells floating in aqueous and hazy slit-lamp beam as it traverses anterior chamber (flare), reflecting disruption of blood-aqueous barrier
  • Tiny opaque deposits on inner corneal surface ("keratic precipitates")
  • Adherence of iris to anterior lens surface ("posterior synechiae")
  • Vitreous cells
  • White cuffing around retinal vessels
  • Gray-white choroidal nodules
  • Lacrimal gland enlargement
  • Conjunctival granulomas
  • Optic neuropathy
  • Third, fourth, sixth, seventh cranial nerve palsies
  • Refer patient to ophthalmologist if diagnosis of sarcoidosis in question, as eye findings may be helpful in diagnosis yet not produce visual symptoms
  • Refer patient non-urgently to ophthalmologist for visual symptoms
  • Eye, surrounding tissues, and visual pathway involved in over 25% of sarcoidosis cases
  • Manifestations usually indolent but may cause severe and irreversible ophthalmic damage
  • Treatment involves topical, periocular, systemic corticosteroids and steroid-sparing immunomodulatory agents
  • Early diagnosis and treatment make a difference!
  • Conjunctival biopsy low diagnostic yield if conjunctiva appears normal