SARCOIDOSIS OF THE EYE
The information on this page has been compiled with the help of specialist Mr Matthews, Consultant Neuro-ophthalmologist, University Hospitals Birmingham and Professor Carlos Pavesio, Consultant Ophthalmologist, Moorfields Eye Hospital.Testing for Eye Inflammation
Ophthalmological examination
An ophthalmologist will examine the front part of the eye with a microscope and an intense light. To view the rear part of the eye, the ophthalmologist will use dilating drops to make the pupil big enough to see the back of the eye.
Schirmer test
Dry eyes are common. The lacrimal gland produces tears – important for keeping the eye moist and protecting from infection. The Schirmer test uses blotting paper to measure the moisture (tears) produced by the lacrimal gland in the lower eyelid.
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1) Inflammation of the Uveal Tract (Uveitis)
The uveal tract comprises of the choroid, the ciliary body and the iris. This is the most common eye problem in sarcoidosis. The inflammation can occur in the iris 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 or gradually.
Symptoms
- the eye is suddenly red and sometimes painful (acute 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 rarely heals spontaneously and usually needs treatment with eye drops. Your ophthalmologist may prescribe two kinds of eye drops: corticosteroids inhibit the inflammation and mydriatic substances (drops to dilate the pupil) prevent adhesion of the iris to the lens. If the inflammation lasts a long time or recurs, corticosteroid treatment in tablet form can be effective (for example prednisolone).
Treating posterior uveitis
Posterior uveitis can persist or recur. The treatment may consist of corticosteroid injections next to the eye, corticosteroid tablets (e.g. prednisolone), sometimes in combination with methotrexate.
Do You Have Uveitis?
The Royal National Institute of Blind People have fantastic and detailed information about uveitis.
You can read it on their website here.
2) Inflammation of the Lacrimal Gland
This type of eye inflammation is rare. The most common problem with this type of inflammation is dry eyes.
Symptoms:
- itchy, burning eyes
- irritation while reading and using screens
- overproduction of tears due to cold, draught and wind
Treatment: Corticosteroids. Artificial tears or ointment can be administered to treat dry eyes.
3) Inflammation of the Conjunctiva
Small bumps (follicles) form in the white of the eye, or on the inner side of the eyelids. This type of eye inflammation is rare.
Symptoms:
- redness (severe inflammation)
- yellowish nodules of the conjunctiva
Treatment: Anti-inflammatory eye drops.
4) Optic Nerve Involvement
The optic nerve can be directly involved by sarcoidosis related inflammation. This can result in significant functional abnormalities.
Symptoms:
- blurred/dim/segmented vision (e.g. lower/upper field blinded)
- reduced colour vision
- pain around the eye or eye socket
Treatment: Consultation with a neuro-ophthalmologist is advised. Corticosteroids in tablet form or by infusion. Other immunosuppressants may be required.
Neurosarcoidosis and the Eye
The proper functioning of the eye can be affected by neurosarcoidosis. This is sometimes confused with ocular sarcoidosis. For more information on how neurosarcoidosis can affect the eye, see SarcoidosisUK’s patient information leaflet Sarcoidosis and the Nervous System.
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 become opaque (cataract) and the intraocular pressure can increase (glaucoma). Glaucoma is treated with eye drops and may require surgery in extreme cases. The cataract lens can be replaced by an artificial lens.
Macular oedema: Prolonged uveitis causes retinal swelling which can kill the light-sensitive cells. This can cause permanent ocular damage in sarcoidosis uveitis patients. Treatment may include corticosteroid injections, tablets, or another immunotherapy such as biologics.
Inflamed blood vessels (vasculitis): In posterior uveitis and panuveitis, blood vessels can become inflamed, or granulomas (swellings) may occur in the deeper choroid. In severe cases small blood vessels on the retina may leak or close, causing bleeding and swelling. This can lead to oxygen deficiency and create new, weak blood vessels. These are easily susceptible to bleeding. Vasculitis is treated in a similar way to macular oedema. Retinal laser treatment can treat new 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 or good optometrist at least once per year to check for any complications.
Page last updated: February 2023.