Sarcoidosis: A Mimicker of Ocular Cicatricial Pemphigoid

We report a rare case of ocular sarcoidosis presenting as bilateral cicatricial conjunctivitis, initially misdiagnosed as ocular cicatricial pemphigoid (OCP). A 69-year-old woman presented with a five-year history of chronic bilateral ocular irritation, trichiasis, conjunctival injection, and progressive cicatrization. She had previously undergone a conjunctival biopsy at an outside facility several years prior, which was reported without abnormal findings. Despite treatment with topical cyclosporine, artificial tears, and dapsone for presumed OCP, her symptoms persisted. A repeat conjunctival biopsy was eventually performed and revealed nodular epithelioid granulomatous inflammation with stromal fibrosis and scattered Langhans-type giant cells, consistent with ocular sarcoidosis. There was no prior history or systemic evidence of sarcoidosis. The patient was started on oral prednisone with a structured taper and mycophenolate mofetil. At the six-month follow-up, she reported marked improvement in ocular discomfort, with stabilization of cicatricial changes. This case highlights the importance of considering sarcoidosis in the differential diagnosis of chronic cicatrizing conjunctivitis, even in the absence of systemic findings, and underscores the diagnostic role of conjunctival biopsy in guiding management.