Sarcoidosis and its ocular manifestations

Sarcoidosis is a significant cause of pulmonary dysfunction and ocular morbidity. The worldwide distribution of sarcoidosis involves primarily Caucasians, however, within the United States, the disease is nearly confined to the African American population. Although genetic and environmental factors have been implicated, a definitive cause of the disease, at present, remains unknown.

A review of the epidemiology, pathogenesis, and clinical features of non-ocular and ocular sarcoidosis is presented along with current thoughts on the applicability of diagnostic studies and treatment options available for afflicted patients.

Epithelial, non-caseating granulomas are the hallmark histological findings of sarcoidosis and can be found in virtually all body tissues. The inflammatory response is a delayed hypersensitivity (type IV) reaction with an abundance of helper T-cells (CD4+). Although pulmonary findings are most common, ocular involvement with sarcoidosis occurs in approximately 25 percent of all cases. Posterior segment inflammation occurs in upwards of 28 percent of all cases of ocular sarcoidosis and is a major cause of visual morbidity among these patients.

Sarcoidosis should be suspected in cases of granulomatous uveitis. Laboratory studies may be corroborative but should not be considered diagnostically specific or prognostic with regard to treatment. Ocular involvement often suggests a more progressive or recalcitrant form of the disease with significant pulmonary findings that may benefit from a trial course of oral prednisone.