BACKGROUND: Sarcoidosis is a granulomatous inflammatory disease of unknown etiology that can affect any part of the body. Chronic uveitis and vitritis are the most common ocular findings. However, other less common pathology may be observed in the eye. The following case is that of a young female in whom optic neuritis, the only ocular abnormality, led to the diagnosis of systemic sarcoidosis.
CASE REPORT(S). A 22 year-old white female presented with the complaint of decreased vision in both eyes. Visual examination revealed reduced visual acuity and color vision bilaterally as well as an afferent pupillary defect OS. Automated visual field testing revealed a right homonymous hemianopia. Dilated funduscopic examination showed optic nerve pallor, left greater than right. The remainder of her fundus was normal. MRI of the brain revealed enhancement of the left optic tract and a plain chest radiograph demonstrated hilar adenopathy. Serum angiotensin converting enzyme (ACE) level was elevated. A diagnosis of systemic sarcoidosis was made, and oral corticosteroid therapy was instituted.
CONCLUSIONS. Ocular pathology may occur as part of the systemic manifestations of sarcoidosis. Anterior chronic uveitis, vitritis, and retinal vasculitis are most commonly associated with this inflammatory condition. It is less common to find optic neuritis associated with sarcoidosis, particularly as the sole ocular manifestation. This unusual case demonstrates that ocular sarcoidosis should be considered in the differential diagnosis of optic neuritis.