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Ocular sarcoidosis can involve any part of the eye and its adnexal tissues.
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The most common ocular manifestations are uveitis, dry eye, and conjunctival nodules.
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Ocular involvement is the presenting symptom in approximately 20% to 30% of patients with sarcoidosis.
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Multidisciplinary approaches are required to achieve the best treatment outcomes for both ocular and systemic manifestations.
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With appropriate treatment, visual prognosis is generally good.
Ocular Sarcoidosis
Section snippets
Key points
Sarcoidosis can involve almost any structure
Epidemiology
Ocular involvement of sarcoidosis has been known since the early 1900s and has become more recognized since the mid-1900s.1 Variability in the diagnostic criteria has made epidemiologic studies of ocular sarcoidosis challenging.
The prevalence of ocular involvement in different series ranges widely from 13% (Turkish study) to 79% (Japanese study) in patients with systemic sarcoidosis.2, 3, 4 Ocular involvement is the presenting symptom in approximately 20% to 30%.5, 6 Uveitis was reported in 30%
Clinical manifestations of ocular sarcoidosis
Ocular disease may be the initial manifestation in patients with sarcoidosis and may cause severe visual impairment. The involvement may be characterized by granulomatous inflammation, which can affect any part of the eye and its adnexa. Examples of the clinical presentations of ocular sarcoidosis are listed in Table 1. The most common ocular manifestations are uveitis, dry eye, and conjunctival nodules.
Diagnosis of ocular sarcoidosis
Sarcoidosis is one of several conditions that may simultaneously involve multiple ocular tissues with various presentations. For example, patients may present with acute anterior uveitis with lacrimal gland enlargement, bilateral multifocal choroiditis with conjunctival nodules, or peripheral ulcerative keratitis with orbital inflammation. Sarcoidosis should be particularly high on differential diagnoses in those with involvement of multiple ocular tissues.
The gold standard for the diagnosis of
Treatment of ocular sarcoidosis
The primary aims for the management of ocular sarcoidosis are to restore vision and to prevent complications from related inflammation. Corticosteroid therapy, including topical, regional, and systemic routes, is the mainstay of treatment. Other immunomodulators may be required in some patients who are dependent, unresponsive, or intolerant to corticosteroid treatment.
Prognosis of ocular sarcoidosis
Visual prognosis of ocular sarcoidosis may vary depending on the severity and chronicity of eye inflammation, a delay in presentation to a specialist, and ocular complications secondary to uveitis.9 A long-term prognostic study of sarcoid uveitis showed that most (54%) patients retained vision of better than 20/40 in both eyes and that only 4.6% had lost vision less than 20/120 in both eyes, at 10 years after the onset of uveitis in a setting of an ophthalmic referral center.120 The main causes
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Dr S. Pasadhika has no conflict of interests to disclose.
Dr J.T. Rosenbaum is a consultant for Abbvie, UCB, Genentech, Medimmune, Xoma, Portage, Auventx, Santen, Sanofi, and Regeneron.