Sarcoidosis-Related Uveitis: A Review

Abstract

Sarcoidosis is an inflammatory disease that involves the eyes in 10–55% of cases, sometimes without systemic involvement. All eye structures can be affected, but uveitis is the most common ocular manifestation and causes vision loss. The typical ophthalmological appearance of these uveitis is granulomatous (in cases with anterior involvement), which are usually bilateral and with synechiae. Posterior involvement includes vitritis, vasculitis and choroidal lesions. Tuberculosis is a classic differential diagnosis to be wary of, especially in people who have spent time in endemic areas. The diagnosis is based on histology with the presence of non-caseating epithelioid granulomas. However, due to the technical difficulty and yield of biopsies, the diagnosis of ocular sarcoidosis is often based on clinico-radiological features. The international criteria for the diagnosis of ocular sarcoidosis have recently been revised. Corticosteroids remain the first-line treatment for sarcoidosis, but up to 30% of patients require high doses, justifying the use of corticosteroid-sparing treatments. In these cases, immunosuppressive treatments such as methotrexate may be introduced. More recent biotherapies such as anti-TNF are also very effective (as they are in other non-infectious uveitis etiologies).

Insights into the diagnosis and management of sarcoid uveitis: A review

“…Optic nerve granulomas (Figure 3C) and solitary choroidal granulomas (Figure 3D) are rare but highly suggestive of sarcoidosis 50 7. Choroidal granulomas evolve into atrophic scars of the pigmentary epithelium 51 (Figure 3B) high visual morbidity, ocular biopsy is generally unacceptable for most individuals. The exception is when conjunctival granulomas are present, as these are easily accessible with positive yields up to 67% (see below).…”

“…Additionally, the diagnostic performance is low in ocular sarcoidosis with a sensitivity of 3%-5.2%. 51…”

“…11 The most common complications are cataract, CMO, ocular hypertension and glaucoma. 51,111 Trabecular nodules contribute to elevated IOP, 12 and glaucoma is more common in those with angle signs. 13 The five-year cumulative risk of glaucoma in sarcoidosis is 9.9% (CI 6.1-15.9).…”

“…134 Biologic DMARDs (bDMARDs) are then used as third-line therapies if necessary. 51,121,129 Sarcoidosis refractory to cDMARDs is uncommon and should prompt further investigation for other granulomatous disease mimicking sarcoidosis such as TB, Whipple's disease, granulomatosis with polyangiitis and neoplasms. 129 Paradoxically anti-TNFalpha agents can actually induce a sarcoid-like granulomatous inflammation, the prevalence of which is estimated at 0.04%.…”

Association between immune checkpoint inhibitor medication and uveitis: a population-based cohort study utilizing TriNetX database

“…Our study further benefited from propensity score matching, longitudinal design, and extended follow-up duration. Additionally, we enhanced the validity of our study by excluding other confounding conditions related to uveitis ( 6 , 8 , 14 , 40 – 42 )…”