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