Asymptomatic Uveitis as Primary Manifestation of Sarcoidosis

Aim: To emphasize that ocular involvement in sarcoidosis may be the initial manifestation of the disease and can be completely asymptomatic.

Presentation of Case: A 36 year-old female was referred to uvea service with detection of keratic precipitates and anterior chamber cells during routine eye examination. She did not show any symptoms of uveitis. A slit lamp examination revealed bilateral medium-sized, round, centrally located granulomatous keratic precipitates on corneal endothelium and +1 cell reaction in anterior chamber. Dilated fundus examination showed bilateral vitreous cells and small vitreous opacities in the right eye. Serum levels of angiotensin-converting enzyme were increased. Her chest X-ray study was significant for bilateral hilar adenopathy, and transbronchial needle aspiration biopsy confirmed the diagnosis of sarcoidosis. Patient responded well to systemic steroid therapy with complete disappearance of the signs.

Discussion: Ocular involvement in sarcoidosis may occur as the disease process, it also can be the first clinical manifestation of the disease. Although the incidence of pulmonary involvement is nearly one and half times higher than ocular involvement, the most frequent initial symptom of sarcoidosis is eyesight disorder. The reason for that is late emergence of symptoms caused by lung involvement such so symptoms related to ocular involvement generates the major complaints at the first application.

Conclusion: Early diagnosis of sarcoidosis is important for avoiding ocular complications as well as prevention of other system involvements. Ophthalmologists have a critical role in the diagnosis and follow-up of the disorder because of increasing incidence of the ocular involvement.