Unilateral papilloedema in a 12 year old girl--a surprising diagnosis

A previously well 12 year old girl presented with diminished visual acuity and haziness of her left eye. Her examination confirmed visual loss in her left eye and significant disc blurring on fundoscopy. Extensive investigations including computerised tomography of the brain and orbit were normal. Her serum angiotensin converting enzyme (ACE) levels were elevated and subsequent Kveim test was positive confirming the diagnosis of ocular sarcoidosis. She did respond to a course of systemic steroids and over the following 3 years her eye signs and symptoms did correlate well with the ACE level. To date she has not had any systemic or respiratory symptoms. Thus sarcoidosis should be considered in the differential diagnosis of ocular pathology of unexplained aetiology.