Autoimmune retinal dysfunction in sarcoid chorioretinopathy

Visual loss, photophobia and night-blindness in a middle-aged patient with a previous history of cancer are highly suggestive of cancer-associated retinopathy.

A 63-year-old man complained of slowly progressive bilateral visual loss, photophobia and night-blindness. His past medical history was remarkable for surgical and medical treatment of a carcinoma of the base of his tongue nine years earlier. Visual acuity was 0.3 RE and 0.15 LE, with constricted visual field in both eyes. Ocular examination and fluorescein angiography were non-relevant. Electroretinography revealed diffuse cone and rod dysfunction. ICG angiography showed multiple small widespread hyperfluorescent spots. A chest CT scan revealed multiple focal lesions which were biopsied. Histological diagnosis was sarcoidosis.

Upon systemic steroid therapy, visual function gradually improved, and ICG anomalies disappeared. Vision recovered to 1.0 RE and 0.8 LE with normal visual field in both eyes.

Sarcoidosis may present as an autoimmune retinal dysfunction with photophobia and night blindness as the presenting symptoms.