Summary for the Clinician Sarcoidosis

• Multisystemic granulomatous disease of unknown aetiology

• May affect any ocular tissue but posterior segment inflammation in 30% of the ocular involvement

• Fundus findings: choroiditis and retinal inflammation can occur together or separately. Retinal periphlebitis and characteristic vascular sheathing (candle-wax) are generally present. Cystoid macular edema and papillitis may be associated

• Investigations: chest X-ray or CT scan to detect hilar or mediastinal lymphadeno-pathy, skin test for anergy to tuberculin, serum angiotensin converting enzyme (ACE) and serum lysosyme elevation. Gallium scintigraphy to detect increased uptake signalling presence of granuloma

• ICGA: hypofluorescent dark dots present in the early and intermediate phases (granulomas). Focal hyperfluorescent pinpoints in the lesional areas in the late phase. Fuzzy choroidal vessels in the intermediate phase and diffuse hyperfluorescence due to choroidal staining in the late phase

• FA: may show retinal vasculitis, disc hyper-fluorescence, and cystoid macular edema when present

• Treatment: corticosteroids. Indication and method of administration (sub-Tenon's injection, systemic) depend on severity of the lesions. Immunosuppressive agents may have to be added

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