Ocular Sarcoidosis

Abstract

A 13-year-old adolescent was admitted to our clinic with a history of otalgia, odinophagia, and subconjunctival hemorrhage (red eye). After the patient had used ophthalmic tobramycin/dexamethasone and oral amoxicillin for 3 days, prescribed when she was seen in an emergency service, the conjunctival lesion had not improved. On admission, examination of the patient revealed unilateral temporal nodular episcleritis (Table) of her left eye (arrow), arthritis of her left ankle, symmetric erythema nodosum on her legs, and a fever (temperature, 38ºC). Ocular sarcoidosis was diagnosed by conjunctival biopsy; the specimen showed a noncaseating granuloma. Culture was negative for bacteria, fungus, and parasites. The patient had no reaction to the tuberculin test, had no signs of intrathoracic disease, and the levels of the angiotensin-converting enzyme as well as serum and urinary calcium were normal. The lesion resolved after 2 months of treatment with ophthalmic dexamethasone.Sarcoidosis is less common in children than in adults. In a 15-year study in Denmark, the incidence of sarcoidosis was 0.06 case per 100,000 children 4 years of age or younger; it increased gradually with age to 1.02 cases per 100,000 adolescents 14 to 15 years of age. In adolescents, the clinical picture was similar to that in adults. 2 Uveitis or iritis is the most common manifestation, occurring in 24% to 56% of children, followed by conjunctival granulomas. 2,3 1. Watson PG, Hayreh SS. Scleritis and episcleritis.