Sarcoidosis presents with ocular involvement in 20–30% of patients1, with the most common ocular manifestations being granulomatous uveitis, dry eye, and conjunctival nodules. Pain may be caused by ciliary spasm or elevated intraocular pressure, and granulomas of the choroid cause visual disturbance only when they are located in the macula or center of vision, unlike the peripheral lesion in our patient2.
A 32-year-old man with no systemic complaints presented with floating spots and blurred vision in the left eye for 1 week. Fundus examination revealed bilateral intraretinal hemorrhages and classic perivascular sheathing of retinal veins known as “candle wax drippings,” with a macular star and elevated inferior granuloma in the left eye (Figure 1). The differential diagnosis of these findings includes sarcoidosis, syphilis, tuberculosis (TB), multiple sclerosis, cytomegalovirus retinitis, Eales disease, Vogt-Koyanagi-Harada disease, intraocular lymphoma, and toxoplasmosis3. Testing revealed a negative TB test and an elevated angiotensin-converting enzyme level. Chest radiograph showed bilateral hilar lymphadenopathy, and a bronchial biopsy showed granulomatous disease secondary to sarcoidosis.
There is no consensus on the diagnostic criteria for ocular sarcoidosis; however, the gold standard for diagnosis is a tissue biopsy, most commonly retrieved from the lungs or skin but may be obtained from conjunctiva or the lacrimal gland. Treatment for ocular sarcoidosis usually includes steroid and cycloplegic eye drops, and systemic immunosuppressive and biologic agents. Irreversible vision loss may be caused by glaucoma and chronic maculopathy related to chronic inflammation; this highlights the importance of a multidisciplinary approach when treating sarcoidosis2.
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