Uveitis
Sarcoidosis
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Get access- Multisystem granulomatous disorder: 0.1% of population
- 25% have ophthalmic involvement
- F>M
- Unknown cause: there may be an infectious trigger in susceptible individuals
Clinical features
- Anterior uveitis
- Intermediate uveitis
- Posterior uveitis: CMO, periphlebitis, vascular occlusions, neovascularisation, retinal nodules (granulomata), disc swelling, peripheral multifocal chorioretinitis (small punched out atrophic spots) is highly suggestive
- Iris nodules: Koeppe (pupillary border) and Busacca (iris surface)
- Optic nerve granuloma
- Conjunctival granulomas
- Band keratopathy
- Systemic features
- Dry cough, dyspnoea
- Pericarditis, cardiomyopathy, conduction defects, heart failure
- Erythema nodosum, cutaneous granulomata, lupus pernio
- Arthritis
- Glandular swelling
- Cranial nerve palsies, peripheral neuropathy, myopathy, atypical optic neuritis
Sarcoid syndromes
- Heerfordt’s: parotid/submandibular enlargement, VII palsy, uveitis
- Lofgren’s: fever, erythema nodosum, BHL
- Mickulicz’s: lacrimal/salivary swelling
Tests
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Serum ACE (positive in 60-90%): false negatives if on ACE-inhibitors
- Also high in: children, mycobacterial infection, chronic lung diseases, Gaucher’s disease
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CXR: bilateral hilar lymphadenopathy
- CXR is the best screening test since it is abnormal in >90% of patients with sarcoid
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HRCT thorax
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MRI brain/optic nerves with gadolinium +/- LP in suspected neurosarcoid
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PET-CT
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Biopsy: transbronchial, conjunctival: non-caseating granulomata with whorls of epithelioid cells around multinucleated giant cells
- Macrophages stain with CD68
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FFA: ischaemia, leakage, new vessels, CMO
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ICG: choroidal stromal vasculitis