The most common eye problem in sarcoidosis is inflammation of the uveal tract, called uveitis. Sarcoidosis causes inflammation and tiny nodules named granulomas, and it can affect almost every system of the body. In the eye, the uvea is the middle, blood-rich layer. It has three parts: the iris, the ciliary body, and the choroid. When that layer becomes inflamed, the patient may have pain, light sensitivity, redness, and blurred vision.
Sarcoid inflammation leaves signs you can learn to expect. There may be cell deposits on the cornea and inflammatory cells in the anterior chamber, the fluid-filled space in front of the iris. Inflammation of the iris alone is called iritis. Inflammation in the vitreous, the gel behind the lens, is called vitritis. Sticky inflammation can scar the pupil down to nearby tissue, and those scars are synechiae. In some patients the disease reaches the choroidal and retinal vessels, the optic nerve, and the lacrimal gland. Treatment is with topical or systemic corticosteroids, meaning steroid drops or steroid medicine taken by mouth. Because uveitis can return, these patients often need prompt appointments when they report a red or aching eye. Ask about pain, light sensitivity, and blurring when you take the history. Record the medicines she takes for sarcoidosis, since steroid use over time can raise eye pressure and cloud the lens. Pass all of that along to the doctor.
Tie the two words together and you have the fact: sarcoidosis means think uveitis. Matching a body-wide disease to the eye tissue it attacks is central to the COA content area on general medical knowledge.
Incorrect Answers
- A. A subconjunctival hemorrhage is usually from coughing, straining, or minor trauma, not from sarcoid inflammation.
- B. Droopy lids on both sides suggest myasthenia gravis or simple aging changes in the lid.
- C. A cataract can follow long steroid use, but it is not the most common finding in this disease.
Testing Pearls
- Sarcoidosis most often shows in the eye as uveitis.
- The uvea is the iris, ciliary body, and choroid.
- Sarcoid findings include corneal deposits, iritis, vitritis, and synechiae.
- Its typical lesions are called granulomas.
- Treatment uses topical or systemic corticosteroids.
References
- American Academy of Ophthalmology. Ophthalmic Medical Assisting: An Independent Study Course. Chapter 4, Systemic Diseases and Ocular Manifestations.
