Ocular sarcoidosis is an inflammatory disorder that primarily affects the eyes and is commonly associated with systemic sarcoidosis, a condition characterized by the formation of noncaseating granulomas in various organs, most frequently the lungs and lymph nodes. It is the second most common manifestation of sarcoidosis after pulmonary involvement, and it can result in significant morbidity if not adequately managed.

The clinical presentation of ocular sarcoidosis is highly variable, with symptoms ranging from mild irritation to severe visual impairment. Common ocular manifestations include uveitis, optic neuropathy, and retinal involvement, which can lead to chronic inflammation, irreversible damage, and vision loss if untreated. In fact, uveitis is the most common presentation, and it has been reported that up to 25% of patients with systemic sarcoidosis will experience ocular involvement during the course of their disease (1).

The diagnosis of ocular sarcoidosis is challenging due to the lack of a specific biomarker, and it often requires a comprehensive evaluation involving detailed clinical history, slit-lamp examination, imaging, and histopathological confirmation of granulomatous inflammation. Although some studies have proposed diagnostic criteria, there is still no universally accepted guideline (2).

Treatment primarily focuses on controlling inflammation and preventing vision-threatening complications, with corticosteroids being the cornerstone of therapy. In more severe cases, steroid-sparing agents such as methotrexate and azathioprine may be employed (3).

The long-term prognosis of ocular sarcoidosis varies, with many patients achieving good visual outcomes if treated promptly and adequately, while others may experience chronic inflammation and complications, such as cataract formation and glaucoma. Moreover, the management of ocular sarcoidosis requires multidisciplinary collaboration between ophthalmologists and other specialists, given the potential for systemic involvement and the need for coordinated care (4- 6).

This study aims to examine the clinical profile and management outcomes of ocular sarcoidosis, focusing on the demographic characteristics, common ocular manifestations, treatment protocols, and the long-term visual prognosis of affected individuals.

Ocular sarcoidosis is an inflammatory disorder that primarily affects the eyes and is commonly associated with systemic sarcoidosis, a condition characterized by the formation of noncaseating granulomas in various organs, most frequently the lungs and lymph nodes. It is the second most common manifestation of sarcoidosis after pulmonary involvement, and it can result in significant morbidity if not adequately managed.

The clinical presentation of ocular sarcoidosis is highly variable, with symptoms ranging from mild irritation to severe visual impairment. Common ocular manifestations include uveitis, optic neuropathy, and retinal involvement, which can lead to chronic inflammation, irreversible damage, and vision loss if untreated. In fact, uveitis is the most common presentation, and it has been reported that up to 25% of patients with systemic sarcoidosis will experience ocular involvement during the course of their disease (1).

The diagnosis of ocular sarcoidosis is challenging due to the lack of a specific biomarker, and it often requires a comprehensive evaluation involving detailed clinical 

The study included 40 patients (50 eyes) diagnosed with ocular sarcoidosis, with a mean age of 34.9 years and a predominant female representation (62.5%). The most common age group was 31-40 years (42.5%), and bilateral involvement was observed in 25% of cases. The clinical presentation was characterized by defective vision, which was seen in 95% of patients, followed by pain (60%), redness (50%), and photophobia (30%).

Table 1: Demographic characteristics and visual acuity at the time of presentation

Radiologically, 50% of patients exhibited bilateral hilar lymphadenopathy, while serum ACE was elevated in 30% of patients. Treatment was primarily corticosteroid-based, with 100% of patients receiving topical steroids, and 90% receiving oral steroids. The visual outcome at 6 months showed that 37.5% of patients had improved vision, while 50% had no change. However, 12.5% experienced deterioration, indicating that while the majority showed stability or improvement, some cases did not respond well to the treatment. This underscores the need for personalized treatment strategies in managing ocular sarcoidosis.

Table 3: Management and outcomes

This study was undertaken to analyze the clinical profile and treatment outcomes of ocular sarcoidosis over a one-year period at Narayana Medical College, Nellore. The results of this study align with findings from similar studies on ocular sarcoidosis, with common manifestations including defective vision, pain, redness, and photophobia. For instance, a study by Jabs et al. (1) reported that uveitis was the most frequent ocular manifestation, which is consistent with the high prevalence of uveitis observed in the present cohort. Furthermore, the predominance of female patients (62.5%) in this study mirrors the gender distribution found in study by Ianetti et al. (7), where women were more frequently affected by ocular sarcoidosis, though some studies report a more balanced gender ratio. The age distribution in the present study, with a peak in the 31-40 years group, is also similar to findings by Lee et al. (8), who noted a higher incidence of ocular involvement in adults aged 30-40 years.

However, some differences were noted. In this study, the proportion of patients with bilateral involvement (25%) was lower than the 50% observed by Mandeep et al. (9), which could be attributed to regional differences or variations in the study design. The visual acuity at the time of presentation also showed a noteworthy proportion (20%) of patients with significantly impaired vision (6/60 or below), which is higher compared to the findings of Tamer et al. (10), where the majority of patients had a relatively better visual acuity at presentation. This discrepancy might suggest variations in the severity or chronicity of the disease in different populations.

The management outcomes observed in the current study also reflect trends seen in other research. The use of corticosteroids as the first-line treatment, followed by immunosuppressive agents like methotrexate and azathioprine, aligns with treatment protocols described by Nishida et al.(11) and Sakamoto et al. (12) The improvement in visual acuity, as defined by a two-line gain on the Snellen chart, is consistent with the therapeutic success noted in studies like that of Gülmez et al. (13), where corticosteroid therapy demonstrated significant improvement in ocular sarcoidosis patients.

This study was undertaken to analyze the clinical profile and treatment outcomes of ocular sarcoidosis over a one-year period at Narayana Medical College, Nellore. The results of this study align with findings from similar studies on ocular sarcoidosis, with common manifestations including defective vision, pain, redness, and photophobia. For instance, a study by Jabs et al. (1) reported that uveitis was the most frequent ocular manifestation, which is consistent with the high prevalence of uveitis observed in the present cohort. Furthermore, the predominance of female patients (62.5%) in this study mirrors the gender distribution found in study by Ianetti et al. (7), where women were more frequently affected by ocular sarcoidosis, though some studies report a more balanced gender ratio. The age distribution in the present study, with a peak in the 31-40 years group, is also similar to findings by Lee et al. (8), who noted a higher incidence of ocular involvement in adults aged 30-40 years.

However, some differences were noted. In this study, the proportion of patients with bilateral involvement (25%) was lower than the 50% observed by Mandeep et al. (9), which could be attributed to regional differences or variations in the study design. The visual acuity at the time of presentation also showed a noteworthy proportion (20%) of patients with significantly impaired vision (6/60 or below), which is higher compared to the findings of Tamer et al. (10), where the majority of patients had a relatively better visual acuity at presentation. This discrepancy might suggest variations in the severity or chronicity of the disease in different populations.

The management outcomes observed in the current study also reflect trends seen in other research. The use of corticosteroids as the first-line treatment, followed by immunosuppressive agents like methotrexate and azathioprine, aligns with treatment protocols described by Nishida et al.(11) and Sakamoto et al. (12) The improvement in visual acuity, as defined by a two-line gain on the Snellen chart, is consistent with the therapeutic success noted in studies like that of Gülmez et al. (13), where corticosteroid therapy demonstrated significant improvement in ocular sarcoidosis patients.

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