Ocular Sarcoidosis: Symptoms, Causes, and Diagnosis

Sarcoidosis is a disease that causes small masses of tissue clumps, called granulomas, to form inside the body. These granulomas can lead to damaged or malfunctioning organs in the body, and frequently involve the eyes. Uveitis (inflammation inside the eyes) is the most serious manifestation of sarcoidosis in the eyes. Uveitis causes eye pain, redness, and loss of vision and must be treated immediately with steroids by an ophthalmologist.

Anywhere from 25 to 80 percent of sarcoidosis patients have symptoms that affect the eyes at some point. Many of these patients complain of burning, itching, redness, dry eyes, and sometimes watery eyes. Some patients report blurred vision and may complain of sensitivity to sunlight. Sarcoidosis patients also have small, pale yellow bumps on the eye. Depending on where the inflammation occurs within the eye, the following symptoms may develop:

• Dry eyes
• Itchy, burning eyes
• Red and sometimes painful eyes
• Blurred vision
• Seeing black spots or strings
• Sensitivity to light
• Reduced color vision

Sarcoidosis is a disease that may affect many different organs of the body but mostly affects the lungs. The disease usually occurs in adults ages 20 to 40 years of age. Some people may develop uveitis as a complication of sarcoidosis. Uveitis is an inflammation of the uvea or blood-rich membranes in the eye. The uvea is located in the center of the eye, between the sclera and the retina. In uveitis, white blood cells rush to the front of the eye, making the eye very sticky. This stickiness can cause internal structures such as the iris and lens to stick together, sometimes resulting in an increase in eye pressure. Patients may complain of pain in their eye as well as redness, and mild to extreme light sensitivity. Although rare, blindness may occur if the uveitis is left untreated.

An ophthalmologist will examine the front part of your eye with a lighted microscope. Your pupils will be dilated with dilating drops in order to view the back of the eyes. The doctor will look for any signs of inflammation. Since dry eyes are common with sarcoidosis, the tear-producing lacrimal glands will be evaluated using the Schirmer test. The Schirmer test uses blotting paper to measure the moisture (tears) produced by the lacrimal gland in the lower eyelid.

Treatment depends on the area of the eye affected. Your ophthalmologist may prescribe anti-inflammatory eye drops to reduce the inflammation. Dilating drops can be used to prevent adhesion of the iris to the lens. Artificial tears can be used to treat the drying of the lacrimal glands. In stubborn cases, corticosteroid treatment (tablets are taken orally) can be effective.

Since eye problems are common with sarcoidosis, it is important to detect them at an early stage. Proper monitoring and treatment can slow or prevent permanent damage. It is a good idea for sarcoidosis patients to see an eye doctor at least once per year to check for any complications.

Although sarcoidosis most often affects the lungs, lymph nodes, and liver, it can also cause problems with the eyes, spleen, brain, nerves, heart, tear glands, salivary glands, sinuses, bones, and joints. If you are diagnosed with sarcoidosis, an annual, comprehensive eye examination by an optometrist or ophthalmologist is recommended for the first few years after diagnosis, and then as needed.