Proliferative Sarcoid Retinopathy With Bilateral Tractional Retinal Detachment

A 28-year-old male patient without previously diagnosed systemic disease or any ocular history presented with 3 months of progressive blurred vision in both eyes. His ocular exam revealed bilateral vitreous hemorrhage, tractional retinal detachments (TRDs), and extensive retinal neovascularization (NV). His systemic workup revealed elevated angiotensin-converting enzyme, bilateral hilar, and mediastinal adenopathy on computed tomography (CT) chest scan, and extensive multifocal leptomeningeal-enhancing nodules within the posterior fossa on magnetic resonance imaging (MRI) brain scan, confirming sarcoidosis with neurologic and ocular involvement. Ocular complications of sarcoidosis predominantly involve the anterior segment, with anterior uveitis as the most common presentation overall. While posterior findings of ocular sarcoidosis are less common, these include but are not limited to retinal periphlebitis with candlewax drippings, choroidal granulomas, and optic nerve involvement, with cystoid macular edema representing the leading cause of vision loss. This report presents a unique case of bilateral TRDs and retinal NV as the initial manifestation of sarcoidosis. Improved awareness of atypical ocular presentations of sarcoidosis is critical for facilitating earlier diagnosis and timely intervention.