Ocular sarcoidosis

Abstract

Purpose of review Ocular involvement in sarcoidosis is present in up to 80 percent of patients and is frequently manifested before diagnosis of the underlying systemic disease. Considering the therapeutic consequences, early diagnosis of the underlying disease is advantageous in patients presenting with ocular inflammation. There are several ocular findings suggestive of underlying sarcoidosis, such as granulomatous keratic precipitates, iris nodules, cells in the vitreous humor known as snowballs and snowbanks, and retinal periphlebitis. High suspicion is crucial for the diagnosis of sarcoidosis. This review on ocular sarcoidosis will mainly focus on new diagnostic and treatment modalities. Recent findings Recent studies found possible new diagnostic indicators for the diagnosis of ocular sarcoidosis which include not only serum profiles but also vitreous sample analysis. Ophthalmologic imaging techniques have improved to investigate the ocular structure in detail. Results from recent uveitis clinical trials have included sarcoidosis as an underlying cause and have reported positive results. Summary The diagnosis of ocular sarcoidosis can be challenging in some cases. High suspicion is important to diagnose ocular sarcoidosis with various laboratory and ophthalmic tools. There are many possible options for the treatment of ocular sarcoidosis including various biologic agents.

<p>Refractory Sarcoidosis: A Review</p>

“…47 For skin and eye improvement, clinical assessment is generally sufficient to judge treatment efficacy (visual acuity improvement, reduced skin lesions size, reduced steroid use, reduced flares). 48,49 In cardiac sarcoidosis, left ventricular ejection fraction improvement and suppression or lowering of 18-fluorodeoxyglucose uptake in positron emission tomography help to assess treatment efficacy. 50,51 In neurosarcoidosis trials, the ePOST or extrapulmonary physician organ severity tool is the most commonly used efficacy assessment tool 52,53 even if clinical improvement, resolution of gadolinium uptake on magnetic resonance imaging, and improvement in cerebrospinal fluid inflammation are also used and may represent easier ways to ensure correct evaluation of treatment efficacy.…”

Management of chronic ocular sarcoidosis: challenges and solutions

“… 20 An estimated 20%–30% of patients present with de novo ophthalmic findings compatible with sarcoidosis but lack of evident extraocular disease. 20 – 22 Up to 80% (25%–80%) of sarcoidosis patients will develop ocular involvement at some point during the course of the disease. This estimate is subject to considerable variation, based on the population studied and the duration and frequency of ophthalmic follow-up.…”

“…This estimate is subject to considerable variation, based on the population studied and the duration and frequency of ophthalmic follow-up. 22 – 24 Ocular involvement has been reported in 64%–89% of patients with sarcoidosis in Japanese studies. 23 Although ocular sarcoidosis has been described to occur in the absence of any apparent systemic involvement, the frequency of this has yet to be investigated.…”

“…Sarcoidosis-related uveitis can affect any part of the uvea, leading to anterior, intermediate, and posterior uveitis or panuveitis, with anterior uveitis being the most frequent. 22 The most common form of uveitis encountered in sarcoidosis is acute, bilateral anterior uveitis without posterior-segment involvement. The severity of acute inflammation ranges from mild to severe, with affected patients experiencing varying degrees of redness, ocular pain, photophobia, lacrimation, and decreased vision.…”

“…Complications may develop, such as ocular hypertension, secondary glaucoma, corneal band keratopathy, cataract formation, epiretinal membrane, and cystoid macular edema (CME). 22 , 23 The severity and chronicity of anterior-segment inflammation in conjunction with the need for long-term topical corticosteroids are both to account for these complications.…”