Sarcoid Uveitis

A 44-year-old black man presented to our office with insidious onset of blurred vision. He had no significant past medical history but complained of dyspnea on exertion. On examination, the left pupil was irregular and fixed. A chest film demonstrated bilateral hilar adenopathy. Laboratory findings included normal purified protein derivative test results and elevated angiotensin-converting enzyme levels; pulmonary function studies appeared normal. The work-up yielded a diagnosis of sarcoid uveitis.

This is a granulomatous type of uveitis, writes Dr Chris Derk of Tampa, Fla, a category which also includes toxoplasmosis and tuberculous uveitis. Sarcoid uveitis is associated with minimal pain and a subtle onset of blurred vision and hotophobia. In addition to an irregular and fixed pupil, examination reveals a slight circumcorneal flush and large gray keratic precipitates. Sarcoid uveitis has a chronic course and can involve both the posterior and anterior uvea.

Systemic corticosteroids may be used during active stages of the disease. Glaucoma and cataracts are common complications of uveitis. Dr Derk adds that this patient responded to mydriatics and corticosteroid drops, the standard treatment for sarcoid uveitis, but increased intraocular pressure has since developed, and a cataract has formed in the affected eye as well.