Robert P. Baughman, M.D.; Elyse E. Lower, M.D., Ph.D.; Adam H. Kaufman, M.D.

Disclosures

Semin Respir Crit Care Med. 2010;31(4):452-462. 

In This Article

Abstract and Introduction

Abstract

Ocular disease occurs in approximately a third of sarcoidosis patients. The rate of disease varies around the world, with Japanese sarcoidosis patients having ocular disease in more than 70% of cases. If untreated, ocular disease can lead to permanent visual impairment, including blindness. The most common manifestation is uveitis, with anterior involvement often being self-limiting, whereas posterior involvement can be chronic. The diagnosis of ocular sarcoidosis in patients with known sarcoidosis usually requires a specific examination by an ophthalmologist. For patients presenting with uveitis of unknown etiology, criteria have been proposed for diagnosing ocular sarcoidosis. The treatment of ocular disease ranges from topical therapy to systemic treatments such as methotrexate. Recent reports have demonstrated that monoclonal antibodies blocking tumor necrosis factor can be quite effective for chronic refractory ocular sarcoidosis.

Introduction

Ocular disease is an important manifestation of sarcoidosis.[1] If the inflammatory changes are treated quickly and effectively, vision loss can be reversed and blindness prevented.[2,3] Some patients with newly diagnosed ocular sarcoidosis may have known sarcoidosis due to other organ involvement such as hilar adenopathy with positive bronchoscopy for noncaseating granulomas. However, other patients may present with de novo ocular findings suggestive of sarcoidosis but without obvious extraocular disease. Because ocular disease may be the first manifestation of sarcoidosis, physicians should adapt a multidisciplinary approach to evaluating uveitis. In one large study over half of patients referred for uveitis were found to have an underlying systemic disease, with sarcoidosis being the most common disease identified.[4]

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