Sarcoidosis

Sarcoidosis is a multisystem granulomatous disorder of unknown etiology, characterized by intrathoratic involvement. Ocular involvement is common and occurs in approximately 15 to 25% of patients with sarcoidosis.

The most affected organs by sarcoidosis are the lungs, lymph noed, spleen, skins, eyes, nervous system, and bones and joints. Posterior segment manifestion may account for up to 28% of the lesions seen in patients with ocular sarcoid.

Anterior uveitis is the most common ocular lesion and occurs in approximately 2/3 of patients with ocular sarcoid. The posterior clinical findings include vitreous cellular infiltration, a non-specific vitreitis, and accumulation of vitreous debris, called either “snowballs” or a “string of pearls.” These laser lesions may be similar in appearance to those seen in pars planitis.

Perivascular sheathing of the midperipheral veins usually without occlusion occurs in 10 to 17% of patients with ocular sarcoid. More severe forms of periphlebitis are called “candle wax drippings.”

Deeper chorioretinal lesions can vary in size from small “Dalen-Fuchs-like” granulomas to large choroidal nodules simulating a metastatic tumor.

Treatment is intensive topical corticosteroids, systemic steroids or Methotrexate, and should be directed toward immediately suppressing the inflammation and minimizing and protecting ocular complications.