Sarcoidosis of the Anterior Visual Pathway: 24 New Cases

Abstract

Anterior visual pathway disease may be underrecognized as a presentation of sarcoidosis. Classic fundus findings of periphlebitis and optic granuloma are typically absent. An aggressive diagnostic evaluation may help establish the diagnosis early in its course.

Bilateral Acute Retinopathy with Vitreous Hemorrhage as a First Manifestation of Sarcoidosis: Case Report

“…Serum ACE levels elevated in 65% of sarcoidosis patients; however, normal levels do not exclude the diagnosis of sarcoidosis. 17,18 A tissue biopsy is needed for a definitive diagnosis of sarcoidosis and can usually be performed from an appropriate site, except for intraocular tissue due to the high risk of vision loss. 19 The lung is the preferred biopsy site when it is involved.…”

Pathology of the Optic Nerve

“…15A, B). 28 The anterior optic pathways are involved in approximately 1% to 5% of cases of sarcoidosis. Occult sarcoidosis may present with an isolated optic neuropathy and can be confused with other conditions, such as an optic nerve meningioma.…”

“…Up to 80% of patients have abnormal pulmonary function tests and raised serum angiotensin-converting enzyme levels, and 40% show evidence of past or active uveitis. 28 The imaging appearance also can give a clue: bilateral optic nerve involvement is found in a third of patients, and pathologic enhancement of the optic nerve from the globe to the chiasm is strongly suggestive of sarcoidosis. Enhancement of the frontobasal meninges and enlargement of the lacrimal glands are other features indicative of sarcoidosis.…”

Loss of vision: imaging the visual pathways

“…Sarcoidosis is an inflammatory disorder, which may involve any part of the optic pathway, uveitis and infiltration of the optic nerve being common manifestations [19]. It can also produce lacrimal gland enlargement and chiasmatic lesions (see below).…”