Conjunctival sarcoidosis

A biopsy from the lower conjunctival fornix, whether or not taken from follicles, is a method which yields a positive result in +/- 25% of cases of suspected sarcoidosis. We saw a patient with chronic recurrent follicular conjunctivitis of the upper eyelid, without further ocular symptoms. He was known to suffer from allergy and chronic respiratory disease. As the conjunctivitis did not improve a biopsy was taken from the conjunctiva of the upper eyelid. The specimen showed non-necrotizing epithelioid-cell granulomata with multinucleate giant cells and asteroid bodies, and an increase in reticular fibres. The diagnosis of sarcoidosis was confirmed by finding parabronchial granulomata and a raised level of angiotensin-converting enzyme in the serum. Prolonged local corticoid therapy then gradually cleared up the conjunctival condition.