Aims: Our purpose was to detect the rate of initial manifestation of sarcoidosis in the eye. Material and Methods: We conducted a retrospective chart review in a sarcoidosis clinic in Germany. Ophthalmological data were obtained by using a standardized protocol, including the medical history, any comorbidity, onset and type of ocular manifestation that was evaluated by slit lamp, tonometry and fundoscopy. Results: In the cohort of 1,800 patients (mean age 38.1 ± 11.8 years), diagnosis of sarcoidosis was established most commonly by bilateral hilar lymphadenopathy (96.2%), histopathology (46.9%) or other organ manifestations. The initial clinical presentation of sarcoidosis (mean age 34.1 ± 10.8 years) had often been eye manifestation (21.2%). Within this group, anterior uveitis was most common (76.4%), followed by intermediate (17.3%) and posterior uveitis (4.7%). Conclusions: The eye is commonly the first site for manifestation of sarcoidosis. Ophthalmologists have a critical role in establishing the diagnosis of sarcoidosis.

Tear-film deficiencies are common in sarcoidosis patients, even when clinical symptoms are absent. Observations herein suggest that patients with sarcoidosis may not only suffer from deficiencies of the aqueous layer, but also of the mucin and lipid layers.