Ophthalmic and neuro-ophthalmic manifestations of sarcoidosis

Abstract

Sarcoidosis can affect any part of the visual system: the most common ocular manifestation is uveitis and the most common neuro-ophthalmic manifestation is optic neuropathy. Although diagnosis remains challenging, recent advancements in diagnosis are promising. Emerging biologics with particular efficacy for ocular and neuro-ophthalmic disease provide expanding treatment options for sight-threatening disease.

Ocular sarcoidosis – review

“…Cranial neuropathy is a part of the Heerfordt syndrome, which also includes uveitis, fever and swelling of the parotid gland. Other symptoms of neurosarcoidosis have also been reported, including Horner syndrome, Adie's tonic pupil or Argyll Robertson pupil (20).…”

“…Sarcoidosis also affects the central and peripheral nervous system, and it may cause various symptoms, depending on the location of the granulomas. Neurosarcoidosis, which, according to literature, may be diagnosed in 5-16% of all patients, may be associated with blurred vision as the optic nerve or the optic tract is affected, as well as oedema of the optic disc, secondary to increased intracranial pressure, eyeball mobility disorders, visual hallucinations or disorders of the structure and functioning of the pupils (20). Cranial neuropathy is the most often encountered symptom of neurosarcoidosis.…”

“…Cranial neuropathy is the most often encountered symptom of neurosarcoidosis. In most cases, the facial nerve and the optic nerve are affected (20). Attacking of the optic nerve is usually unilateral and may be isolated, without any dysfunctions of other organs.…”

Management of chronic ocular sarcoidosis: challenges and solutions

“…The cornea is rarely affected directly by the disease, but patients can ultimately develop corneal complications, such as keratoconjunctivitis sicca, superficial punctate keratitis, keratic precipitates, and band keratopathy, due to calcium deposition in Bowman’s subepithelial layer. 32 – 35 …”

“…TNFα is a powerful, pleiotropic, multifunctional, proinflammatory cytokine that plays a principal role in a wide range of autoinflammatory conditions. High levels of TNFα are secreted by alveolar macrophages, thereby contributing to the formation and preservation of sarcoidal granulomas in patients with active disease, 32 indicating that selective blockage of this cytokine could accomplish satisfactory control and remission of inflammation. In fact, it has been advocated that in a considerable number of refractory sarcoidosis cases, failure of corticosteroid or antimetabolite therapy might be due to the significantly increased TNFα release.…”