A persistent inflammatory condition called sarcoidosis can harm one or more body organs and tissues. Granulomas, or clusters of inflammatory immune cells, are present in the organs and tissues that are afflicted. This causes further inflammation, with swelling leading to tissue damage and preventing organs from working as they should
Sarcoidosis, also known as ocular sarcoidosis, affects the eyes in about 50% of cases. Neurosarcoidosis, a condition that affects the neurological system, can also impair eyesight.
Due to the accumulation of granulomas, ocular sarcoidosis can cause inflammation and injury to any area of the eye. The most typical kind of eye involvement in sarcoidosis is uveitis. However, other issues are known, such as inflammation of the tear-producing lacrimal glands, orbital disease, or inflammation of the eye’s surrounding muscles, nerves, and blood vessels changes to the surface of the eye and eyelid, such as thickening of the lid and development of nodules brought on by granuloma accumulation on the conjunctiva, the membrane that lines the eye and covers it.
Uveitis, or inflammation of the eye’s uvea, is one of the most typical side effects of ocular sarcoidosis. The iris, the colored part of the eye, the ciliary body, which regulates the shape of the lens, and the choroid, which houses the blood vessels in the eye, are all parts of the uvea. In addition to the eye, uveitis can also affect the lens, retina, optic nerve, and vitreous (the liquid-filled space inside the eye).
Anterior uveitis affects only the front of the eye, including the iris. Intermediate uveitis, mostly affecting the vitreous, and posterior uveitis, affecting the retina and choroid towards the back of the eye
Panuveitis is a condition that simultaneously affects most or all eye areas. The most prevalent type of uveitis in ocular sarcoidosis, while not the only type, is anterior uveitis. Uveitis can be acute, where it manifests suddenly and lasts only a short while, or chronic, with recurrent bouts of deterioration, such as a flare-up after therapy ends or after a period of inactivity.
Uveitis can result in consequences like glaucoma, which is a rise in eye pressure brought on by inflammation, or cataracts (where the lens becomes cloudy).
Blurred vision or vision loss, light sensitivity (photophobia), floaters (black spots or lines in vision), dry or itchy eyes, red eyes, a burning feeling in the eyes, or eye pain are all common signs of ocular sarcoidosis. They could come before or after other typical sarcoidosis symptoms.
In order to rule out other conditions, a number of tests may be necessary to make the diagnosis of ocular sarcoidosis.
Ocular sarcoidosis is likely if a patient has sarcoidosis and also shows eye symptoms.
As there are various characteristics that are usually present in ocular sarcoidosis, a diagnosis will typically require an eye exam. Nodules on the iris and conjunctiva, mutton-fat keratic precipitates (KPs) on the eye, or opaque patches, also called “snowballs,” in the vitreous are a few examples of these.
To determine whether there is inflammation in the eye, namely in the lacrimal glands, a procedure known as the Schirmer test can be used. To do this, place a piece of blotting paper against the eye and check for any changes in tear or moisture production.
A tiny sample (biopsy) from any nodules on the conjunctiva may be obtained for testing in order to identify ocular sarcoidosis if there are any.
Ocular sarcoidosis does not presently have a cure, however there are treatments to control inflammation and lessen symptoms.
Eye drops containing corticosteroids, such as prednisone or Durezol (difluprednate), can be used to treat mild anterior uveitis in order to lessen inflammation. Inflammation of the orbit and lacrimal gland can also be treated with these. Topical cycloplegic medications, such as cyclopentolate or atropine, widen the pupil and inhibit muscle spasms. They can be used in conjunction with corticosteroids to lessen discomfort.
Systemic steroids may be used to treat more severe anterior uveitis as well as intermediate, posterior, and pan-uveitis. These medications can be taken orally, injected into the eye, or, in rare cases, implanted as a time-release capsule in the eye. Other immune system-suppressing treatments may be used in conjunction with this to prevent the development of granulomas.
Medications that suppress the immune system and reduce inflammation may also be administered to patients who are intolerant to corticosteroids or who are not responding to them. These might, however, make the patient more susceptible to infection. Examples include cyclosporine, mycophenolate mofetil, methotrexate, and CellCept (azathioprine).
If any inflammation is under control, surgery might be necessary if cataracts have developed. Moreover, at times patients suffering from ocular sarcoidosis may develop secondary glaucoma which needs to be managed.
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