Lauren Patty, MD
Contributor
A 48 year old AAF presented to LA County Hospital complaining of decreased vision in the right eye beginning 5 days prior. She also complained of pain (a right-sided head/eye ache) and her review of systems was positive for a chronic cough and fatigue. Her past ocular history was significant for a 2 week episode of a red, painful left eye 2 years ago, treated successfully by an outside ophthalmologist with unknown eye drops. Her exam was significant for decreased vision, brightness sense, and color plates in the right eye and a positive rAPD. Her conjunctiva was slightly irregular adjacent to the limbus in both eyes. Dilated fundus exam showed 2+ disc edema in the right eye. The patient underwent a workup for unilateral optic neuritis and her laboratory results were significant for an ACE level of 92. A chest CT showed hilar lymphadenopathy and calcific lung nodules; bronchoscopy was negative for malignant cells. The patient underwent a conjunctival biopsy and the pathology report was positive for noncaseating granulomas consistent with sarcoidosis.
Sarcoidosis is a multisystem disease characterized by noncaseating epithelioid granulomas. Ocular involvement of sarcoidosis is evident in up to 78% of patients, though neurosarcoidosis occurs in only 5-10% of those. The clinical presentation of sarcoid optic neuropathy varies based on the region of the nerve affected, and may manifest as an acute optic neuritis or progressive pallor. Neurophthalmic manifestations of sarcoidosis are presented as well as diagnostic and treatment protocols from a review of the literature.
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