Ocular involvement sarcoidosis

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Sarcoidosis is a systemic autoimmune granulomatous disease. The cause is unknown.

It may present with fever, cough, shortness of breath, fatigue, bilateral (occurring on both sides) hilar lymphadenopathy (enlarged lymph nodes in the center of the chest which are visible on a plain chest x-ray), erythema nodosum (painful bumps on the shins), alveolitis (inflammation of air sacks in the lungs), acute polymyositis (inflammatory muscle disease), arthritis, lacrimal or salivary gland infiltration (inflammation of the glands that make tears and saliva) or sarcoid nodules of the skin.

It occurs most frequently in young adults (20 to 40 years), and women are affected more often than men. It is more common in people of Scandinavian descent and also in African Americans.

Patients diagnosed with systemic sarcoidosis have a nearly 20 percent incidence of eye (ocular) involvement. The most common ocular or eye sign is unilateral (occurring on one side only), anterior, granulomatous uveitis.

The common clinical ocular findings associated with sarcoid uveitis include hazy vision, pain, photophobia (painful eyes with exposure to light), lacrimation (teary eyes), and conjunctival injection (red eye). Also, cataracts, glaucoma, optic nerve inflammation, hemorrhages of the retina, and paralysis of the muscles that move the eye may all occur.

The clinical features of sarcoidosis mimic those of many rheumatologic diseases, with increasing reports of coexistent autoimmune disease.

Extensive laboratory testing is essential, especially for atypical uveitis or optic neuritis. Testing for anemia, leukemia, syphilis, HIV, lupus, Lyme disease, tuberculosis, arthritis, and ankylosing spondylitis are usually performed. The initial tests should include complete blood count (CBC with differential), purified protein derivative(PPD, anti-nuclear antibody (ANA), angiotensin converting enzyme (ACE), Lyme titer, rheumatoid factor (RF), sickle cell screen, chest x-ray (CXR) and sacroiliac joint imaging. Tests that indicate sarcoidosis most specifically are the chest x-ray and ACE.

Management of the eye disease depends on the underlying problem. Close ophthalmologic surveillance is indicated. Topical steroids along with systemic anti inflammatory therapy consisting of either non-steroidal anti inflammatory drugs and oral steroids are used. In stubborn cases, methotrexate, azathioprine, cyclosporine, and biologic therapy have been used. With retinal involvement, a retina specialist needs to be consulted.

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