Conjunctival Biopsy in Sarcoidosis

Crick, Ronald Pitts; Hoyle, Clifford; Mather, Gordon

doi:10.1136/bmj.2.4949.1180

Cited by 35 publications

(11 citation statements)

References 1 publication

(1 reference statement)

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“…Biopsies from the skin or peripheral lymph nodes may be technically easy. Earlier investigations like fine-needle aspiration of the spleen [21] or biopsy of conjunctival noduli [22], which may have a relatively high diagnostic yield and be easier to perform in experienced hands than commonly thought, are nowadays infrequently used. Erythema nodosum, although typical for acute sarcoidosis, is histologically a panniculitis or vasculitis, so granulomas cannot be found there.…”

Section: Biopsy Proceduresmentioning

confidence: 99%

Diagnosis of Sarcoidosis

Wessendorf

Bonella

Costabel

2015

Clinic Rev Allerg Immunol

100

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The diagnosis of sarcoidosis, a systemic granulomatous disease, is based on a compatible clinical-radiological picture and the histological evidence of noncaseating granulomas. Other diseases mimicking sarcoidosis, mostly infections and other granulomatoses, have to be excluded. There is no single test for sarcoidosis, and the presence of granulomas alone does not establish the diagnosis. Symptoms of sarcoidosis are not specific and can be markedly different according to organ involvement and disease course. Respiratory symptoms and fatigue are the most common symptoms at any stage of disease. Histological confirmation is not needed for Löfgren's or Heerfordt's syndrome and asymptomatic bihilar lymphadenopathy. The radiological staging system is still based on chest radiography, and computed tomography is not mandatory for routine follow-up. (18)F-fluorodeoxyglucose positron emission tomography may be of value in special cases. For assessment of lung involvement and follow-up, pulmonary function tests are necessary with vital capacity being the most important single parameter and diffusion capacity the most sensitive. Bronchoscopy with biopsy is the most common procedure for detection of granulomas, when there is no easier biopsy site like skin or peripheral lymph nodes. Endobronchial ultrasonography-guided transbronchial needle aspiration has replaced mediastinoscopy for evaluation of mediastinal and hilar lymph nodes with a high diagnostic yield. Despite numerous studies, no single biomarker can be reliably used for correct diagnosis or exclusion of sarcoidosis. Genetic testing, despite promising advances, has still not been included in routine care for sarcoidosis patients. The long-term prognosis of sarcoidosis depends on the different organ manifestations: Cardiac or central nervous involvement, together with respiratory complications, is critical. A multidisciplinary approach is necessary for comprehensive care of the sarcoidosis patient.

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Section: Biopsy Proceduresmentioning

confidence: 99%

Diagnosis of Sarcoidosis

Wessendorf

Bonella

Costabel

2015

Clinic Rev Allerg Immunol

100

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“…37 It is controversial whether blind biopsy of normal-appearing conjunctival tissue is of value, with one study reporting a yield of 30%, whereas others have found such biopsies to be fruitless. 39,40 Recently, in vivo confocal microscopy has been advocated for the diagnosis of conjunctival sarcoidosis based on a typical appearance. 41 This technique may also be useful to determine when a conjunctival biopsy will confirm the diagnosis of sarcoidosis.…”

Section: Skinmentioning

confidence: 99%

Extrapulmonary Sarcoidosis

Judson

2007

Semin Respir Crit Care Med

123

120

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Sarcoidosis can affect any organ in the body. Frequently extrapulmonary manifestations of the disease are the major cause of morbidity. Treatment of extrapulmonary sarcoidosis often requires consideration of alternative immunosuppressive agents, topical therapy, or therapy that is not specifically directed against the granulomatous inflammation of the disease. This article reviews the clinical presentation and therapy of extrapulmonary sarcoidosis.

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“…In ophthalmology lacrimal gland biopsies are positive in about 20% of the cases (Weinreb 1984). Blind conjunctival biopsies performed on patients with suspected sarcoidosis give positive results in about 10% of the cases (Crick 1956;Karma 1979). However conjunctival biopsies when taken from suspicious conjunctival follicles can confirm the diagnosis in 40.9% of the cases (Karma 1979).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of bronchoalveolar lavage in ocular sarcoidosis

Bienfait

Hoogsteden²,

Baarsma

et al. 1987

Acta Ophthalmologica

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Bronchoalveolar lavage (BAL) is an investigation which has already proven its value in the diagnosis and follow-up of patients with pulmonary sarcoidosis. It also appears to be a valuable contribution to the diagnosis of patients presenting with ocular sarcoidosis. We evaluated the findings in BAL in 16 cases with suspected ocular sarcoidosis (14 cases of uveitis, one with eyelid-swelling and one with an inflammatory process of the lacrimal gland). BAL was positive in 11 cases e.g. showed a lymphocytosis with predominantly T4+ helper lymphocytes. There was one patient with ocular signs very suspect for sarcoidosis (a perivasculitis with candle wax infiltrates) with a normal percentage T lymphocytes (2%) in BAL. In two cases BAL was positive and showed a subclinical alveolitis, whereas no changes were seen on the chest X-ray and in Angiotensin Converting Enzyme (ACE) level.

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Conjunctival Biopsy in Sarcoidosis

Cited by 35 publications

References 1 publication

Diagnosis of Sarcoidosis

Diagnosis of Sarcoidosis

Extrapulmonary Sarcoidosis

Diagnostic value of bronchoalveolar lavage in ocular sarcoidosis

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