Sarcoidosis

Sarcoidosis is an inflammatory disorder which affects many organs, including the eye. It tends to affect women more than men and it is commonly first diagnosed between the ages of 20 and 50. In the USA, blacks are more likely to be affected than whites by a ratio of 10:1. In Europe, it is commonest in the most northerly countries such as Ireland, Sweden, and Norway.

Symptoms in the eye

Painful red eyes

Numerous floaters

Lumps in the eyelids, conjunctiva, and the eyeball itself

Sight loss

Symptoms outside the eye

No symptoms at all (30%)

Cough, fever, weight loss

Diagnosis

The diagnosis is usually made on examination by an ophthalmologist or a respiratory physician, with the help of special tests

The ophthalmologist would be especially interested in the following clinical signs:

Iritis - 60% have it chronically in both eyes and 40% have it from time to time in one eye at a time.

Cyclitis inflammation of the middle part of the eye

Retinitis and vasculitis inflammation of the posterior part of the eye

Lumps in the eyelids, conjunctiva, and the eyeball itself

Problems with optic nerve which connects the eye to the brain

Tests

Blood test for ACE (angiotensin converting enzyme) usually raised

Blood test for calcium often raised

Chest X-ray frequently shows shadowing due to granulomas

Gallium scan of body shows granulomas

Biopsy and microscopic examination suspect granulomas may be biopsied with the help of an endoscope, a thin

flexible tube passed down the mouth into the lungs. The granulomas have a characteristic microscopic appearance

Kveim test (no longer used) injection of sarcoid tissue from an infected patient under the skin may cause a characteristic skin reaction

Possible complications (most of these are very rare)

Decreased vision

Dry eyes

Lung granulomas, pulmonary fibrosis

Rash on cheeks (lupus pernio)

Red nodular rash on skin

Nerve conduction deficits (neuritis)

Liver granulomas

Heart block

Kidney stones

Follow-up

Every few months depending on severity by an ophthalmologist

Follow-up by respiratory physician or internal medicine specialist may be needed if there are any complications outside the eye

Treatment

Iritis can be treated with topical steroids (Prednisolone [PredForte], Dexamethasone [Maxidex])

Posterior uveitis can be treated by injections of steroid behind the eye or by steroid tablets  

Support group

The World Sarcoidosis Society site has useful information, and plenty of links

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