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Published on: May 23, 2025
Management of ocular sarcoidosis
R P Baughman1, E E Lower, R Ingledue
1Department of Internal Medicine, University of Cincinnati, Cincinnati OH, USA. bob.baughman@uc.edu
Summary
Immunosuppressive therapy effectively manages chronic ocular sarcoidosis, often requiring combination treatments. Anti-tumor necrosis factor (TNF) agents show promise for refractory cases but carry risks of toxicity.
Area of Science:
- Ophthalmology
- Rheumatology
- Immunology
Background:
- Chronic sarcoidosis management involves cytotoxic and anti-tumor necrosis factor (TNF) antibodies.
- A stepwise approach guides treatment decisions.
Purpose of the Study:
- Summarize experience with immunosuppressive agents, particularly methotrexate and anti-TNF antibodies.
- Evaluate treatment efficacy for chronic ocular sarcoidosis.
Main Methods:
- Retrospective review of 1587 sarcoidosis patients over six years.
- Identified patients with definite or probable ocular sarcoidosis.
- Analyzed treatment outcomes for methotrexate and anti-TNF therapies.
Main Results:
- Ocular sarcoidosis affected 465 patients (29%).
- Methotrexate (MTX) was used in 365 patients, with 77% continuing therapy.
- Anti-TNF antibodies (infliximab, adalimumab) were used in 25 patients, with limited sustained responses and noted toxicities.
Conclusions:
- Most chronic ocular sarcoidosis cases respond to immunosuppressive therapy.
- Combination therapy may be necessary for sustained disease control.
- Anti-TNF agents are encouraging for refractory disease but associated with significant toxicity.
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