Optic Neuropathy Caused by a Perineural Sarcoid Lesion
Yasuhiro Takahashi1, Shinjiro Kono1, Aric Vaidya1,2
1Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, JPN.
Cureus
|March 14, 2022
Summary
A rare case of sarcoidosis affecting the optic nerve and lacrimal glands caused vision loss in a 74-year-old woman. Despite steroid treatment, vision did not recover, highlighting treatment challenges in neurosarcoidosis.
Area of Science:
- Ophthalmology
- Neurology
- Rheumatology
Background:
- Sarcoidosis is a multisystem inflammatory disease characterized by noncaseating granulomas.
- Ocular and neurological involvement in sarcoidosis can lead to significant visual impairment.
Observation:
- A 74-year-old woman presented with a six-month history of decreased vision in her left eye, a central scotoma, and optic nerve lesions.
- Imaging revealed bilateral lacrimal gland and extraocular muscle enlargement, along with mediastinal and supraclavicular lymphadenopathy.
- Biopsies confirmed lymphocytic infiltration and noncaseating epithelioid granulomas in affected tissues.
Findings:
- Elevated soluble interleukin-2 receptor levels were noted.
- Pathological examination confirmed sarcoidosis with granulomatous inflammation.
- Despite initial response with steroid pulse therapy and oral prednisolone, visual recovery in the left eye was not achieved.
Implications:
- This case underscores the potential for severe visual morbidity in neurosarcoidosis.
- It highlights the challenges in achieving complete visual recovery even with appropriate treatment.
- Further research into novel therapeutic strategies for ocular sarcoidosis is warranted.
