Ocular sarcoidosis

Figure 31-9 Retinal periphlebitis in ocular sarcoidosis. (Photo courtesy David E Sendrowski, O.D.)...

Khalatbari D, Stinnett S, McCaUum RM, et al. Demographic-related variations in posterior segment ocular sarcoidosis. Ophthalmology 2004 111 357. 

Sensory systems Vision A patient with ocular sarcoidosis developed reduced vision with optic disc hyperemia after long-term treatment with linezolid for osteomyelitis. Vision improved and the hyperemia disappeared after linezolid withdrawal [150 ]. 

Kiuchi K, Miyashiro M, Kitagawa C, Wada S. Linezolid-associated optic neuropathy in a patient with ocular sarcoidosis. Jpn J Ophthalmol 2009 53(4) 420-4. 

Ocular sarcoidosis has been reported in three patients, in two of whom conventional interferon alfa was used and in one peginterferon alfa-2b all had granulomatous panuveitis with choroidal granulomata of various sizes [42 ]. All had also taken ribavirin. The intraocular inflammation was managed by reducing the dose of interferon and all patients received topical glucocorticoids. 

Doycheva D, Deuter C, Stuebiger N, Zierhut M. Interferon-alpha-associated presumed ocular sarcoidosis. Graefe s Arch Clin Exp Ophthalmol 2009 247(5) 675-80. 

Takeuchi M, Oh K, Suzuki J, et al. Elevated serum levels of CXCL9/monokine induced by interferon-gamma and CXCLlOfinterferon-gamma-inducible protein-10 in ocular sarcoidosis. Invest Ophthalmol Vis Sci 2006 47(3) 1063-1068. 

The frequency of ocular involvement in sarcoidosis ranges between 10% and 50% in American and European studies (1). In these reports, extraocular disorders such as lacrimal gland involvement and sicca syndrome were included (1). Ocular sarcoidosis seems to be more common in the Japanese where eye involvement has been reported in 64% to 89% of sarcoidosis patients (1). In the United States, ocular sarcoidosis is more common in African Americans than Caucasians (2,3). The low rates of eye involvement with sarcoidosis in some series may be because of the lack of thoroughness in examination of the eye (1). 

Uveitis is the most common ocular manifestation of sarcoidosis in most series (4,5). Anterior uveitis occurs in 20% to 70% of patients with ocular sarcoidosis (4—6) and typically presents as an iritis or iridocyclitis (1,7). Symptoms include blurred vision, red eyes, painful eyes, and photophobia. However in one-third of patients, the patient may present without ocular symptoms. Therefore, all sarcoidosis patients require a slit-lamp and fundoscopic examination regardless of the presence of ocular symptoms. The slit-lamp examination may reveal mutton-fat keratic precipitates (Fig. 1), which are aggregates of inflammatory cells in the comeal epithelium (1,7). Other lesions of anterior sarcoid uveitis that may be seen with a slit lamp include Busacca nodules on the iris (Fig. 2) and Koeppe nodules on the papillary margin (8). Both these nodules are almost exclusively found when anterior sarcoid uveitis is a chronic condition (8). Chronic anterior sarcoid uveitis may cause cataracts and glaucoma. Since corticosteroid use can also lead to cataract formation and... 

Figure 2 (5ee color insert.) Limbal granulomas on the margin of the iris in a patient with ocular sarcoidosis. 

Posterior uveitis is found in up to 28% of patients with ocular sarcoidosis (Fig. 3) (4,7). This retinal involvement primarily affects the retinal veins. Perivenous infiltrates referred to as candle-wax drippings may be seen (10). Choroidal granulomas are observed in some cases and may result in epithelial atrophy or retinal scarring (8). Posterior uveitis may result in significant vision impairment. 

Making the diagnosis of ocular sarcoidosis when the diagnosis of sarcoidosis has not been established in an extraocular site is problematic because an ocular biopsy is an invasive procedure. Such patients should undergo screening tests for sarcoidosis that should include a chest radiograph (1). A complete... 

All ocular inflammation from sarcoidosis requires treatment because it has the potential to cause permanent vision loss. Corticosteroids are the mainstay of treatment for ocular sarcoidosis (1). Topical corticosteroids (i.e., eye drops) may be used for the treatment of anterior uveitis. Mydriatics are always instilled to suppress the inflammation and avoid synechiae (adhesion of the iris to the lens) (1). Intraocular pressure must be monitored regularly because glaucoma may be the result of sarcoid trabecular nodules or the result of corticosteroid therapy (1). 

Ohara K, Judson MA, Baughman RP. Clinical aspects of ocular sarcoidosis. Eur Respir J Monogr 2005 10 188-209... 

Rothova A, Alberts C, Glasius E, et al. Risk factors for ocular sarcoidosis. Doc Ophthalmol 1989 72 287-296. 

Ohara K, Okubo A, Kamata K, et al. Transbronchial lung biopsy in the diagnosis of suspected ocular sarcoidosis. Arch Ophthalmol 1993 111 642-644. 

Takahashi T, Azuma A, Abe S, et al. Significance of lymphoc3ftes in bron-choalveolar lavage in suspected ocular sarcoidosis. Eur Respir J 2001 18 515-521. Spaide RF, Ward DL. Conjunctival biopsy in the diagnosis of sarcoidosis. Br J Ophthalmol 1990 74 469-471. 

Sarcoidosis is a multisystem granulomatous disease of unknown etiology characterized by the deposition of noncaseating granulomas surroimded by lymphocytes. The infiltrative optic neuropathy in sarcoidosis may be the first and only ocular sign or may occur in conjunction with other ocular manifestations of sarcoidosis such as uveitis, candle-wax drippings (exudates around the retinal vessels), and choroidal granulomas. Optic disc edema... 

Haimovici R, Eoster CS. Sarcoidosis. In Pepose JS, Holland GN, Wilhelmus KR, eds. Ocular infection and immunity. St. Louis,... 

Sarcoidosis may affect any part of the eye. Any ocular inflammation from sarcoidosis mandates treatment because it may lead to permanent vision impairment, and in 2% to 5% of cases, blindness (4,5). 

Jabs DA, Johns CA. Ocular involvement in chronic sarcoidosis. Am J Ophthalmol 1986 102 297-301. 

Smith JA, Foster CS. Sarcoidosis and its ocular manifestations. Int Ophthalmol Clin 1996 36 109-125. 

Rothova A. Ocular involvement in sarcoidosis. Br J Ophthalmol 2000 84 110 116. Islam SM, Tabbara KF. Causes of uveitis at the eye center in Saudi Arabia a retrospective review. Opthalmic Epidemiol 2002 9 239-249. 

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