This patient with a known history of sarcoidosis presented with a swollen optic nerve, vasculitis, and patches of inner retinal opacification.
Learning Points:
Sarcoidosis, similar to syphilis, has a myriad of ocular presentations, including anterior, intermediate, and posterior uveitis, vasculitis, papillitis, and choroidal granuloma.
In our experience, there appears to be little association between active systemic disease and ocular inflammation. Establishing the diagnosis of ocular sarcoid in the absence of a known systemic diagnosis is often difficult.
Sensitivity and specificity are highest for chest CT and, when combined with elevated serum ACE and lymphopenia, are strongly suggestive of systemic sarcoidosis (see Nieder and Sims, AJO 1019;206:149-153).
Another recent publication identified soluble interleukin-2 receptor (sIL-2R) and chest CT evidence of bilateral hilar lymphadenopathy as the most sensitive biomarkers for diagnosing systemic sarcoidosis (Japanese J Ophthalmology 2021;65:191-198).
