SARCOIDOSIS AND THE EYE

About half of all sarcoidosis patients experience eye problems, ranging from dry eyes to inflammation. This leaflet provides information on the four main types of eye inflammation relating to sarcoidosis.

Testing for Eye Inflammation

Ophthalmological examination

An ophthalmologist will examine the front part of the eye with a microscope and an intense light. This is called part of a fundoscopy test. To view the rear part of the eye, the ophthalmologist will use dilating drops.

Schirmer test

The lacrimal gland produces tears. These are important for keeping the eye moist and protecting from infection. The Schirmer test measures the moisture (tears) produced by the lacrimal gland in the lower eyelid.

1) Inflammation of the Conjunctiva

Small bumps, also referred to as follicles, form in the white of the eye, or on the inner side of the eyelids.

Symptoms:

  • disfigurement of the eye

  • pain, feeling of pressure around the eye

  • redness (severe inflammation)

Treatment

Anti-inflammatory eye drops.

2) Inflammation of the Lacrimal Gland

Symptoms:

  • dry eyes

  • itchy, burning eyes

  • irritation while reading and using screens

  • overproduction of tears due to cold, draught and wind

Treatment

Administration of artificial tears or ointment.

3) Deterioration of the Optic Nerve

Deterioration of the optic nerve rarely occurs and is almost always related to an inflammatory disease of the nervous system. Consultation with a neurologist is advised.

Symptoms:

  • blurred/segmented vision (e.g. lower/upper field blinded)

  • reduced colour vision

  • pain around the eye or eye socket

Treatment

Corticosteroids in tablet form or by infusion.

4) Inflammation of the Choroid (Uveitis)

This is the most common eye problem in sarcoidosis. The inflammation can occur in the choroid at the front of the eye (anterior uveitis or iris inflammation), but also at the back (posterior uveitis), or even in both simultaneously (panuveitis). In posterior uveitis and panuveitis there is often inflammation also in the vitreous and on the retina. Uveitis can occur in one eye or both eyes simultaneously. It can occur suddenly, but also gradually.

Symptoms:

  • the eye is suddenly red and sometimes painful (acute onset)

  • insidious blurring of sight (gradual onset)

  • blurred vision

  • black spots or strings in the image

  • sensitivity to light

  • opacities with the movement of the eye

Treating anterior uveitis

Anterior uveitis may heal spontaneously, but usually only after treatment with eye drops. Your ophthalmologist may prescribe two kinds of eye drops; corticosteroids inhibit the inflammation and mydriatic substances prevent adhesion of the iris and the lens. If the inflammation lasts a long time or recurs, corticosteroid treatment in tablet form can be effective (for example prednisone).

Treating posterior uveitis

Posterior uveitis often persists or recurs. The treatment consists of corticosteroid injections next to (not in!) the eye, corticosteroids tablets (e.g. prednisone), sometimes in combination with methotrexate.

Complications of Uveitis

In rare cases of sarcoidosis there may be additional complications surrounding the eye:

Cataracts and glaucoma: Due to the eye inflammation, and long-term treatment with corticosteroids, the lens may be obscured (cataracts) and the intraocular pressure can increase (glaucoma). Glaucoma is treated with eye drops and may require surgery in extreme cases. The eye lens can be replaced by an artificial lens.

Macular edema: Prolonged uveitis swelling can kill the light-sensitive cells in the retina. This can cause permanent ocular damage in sarcoidosis uveitis patients. Treatment may include corticosteroid injections, tablets, or another immunotherapy.

Inflamed blood vessels: In posterior uveitis and panuveitis, blood vessels can become inflamed, or granulomas may occur in the deeper choroid. In severe cases small blood vessels on the retina may leak or close, causing bleeding and puffiness. This can lead to oxygen deficiency and create new, weak blood vessels. These are easily susceptible to bleeding. Retinal laser treatment can treat inflamed blood vessels.

Advice

Eye problems are common in sarcoidosis. It is important to detect eye diseases at an early stage. Proper monitoring and timely treatment can often prevent permanent damage. Sarcoidosis patients should contact an eye doctor at least once per year to check for any complications.