eMedicine Specialties > Ophthalmology > Unclassified Disorders

Sarcoidosis: Follow-up

Author: Andrew A Dahl, MD, Director of Ophthalmology Teaching, Mid-Hudson Family Practice Institute, The Institute for Family Health; Assistant Professor of Surgery (Ophthalmology), New York College of Medicine
Coauthor(s): L Raymond DeBarge, MD, Assistant Professor, Department of Ophthalmology, University of Tennessee College of Medicine at Chattanooga
Contributor Information and Disclosures

Updated: Dec 5, 2008

Follow-up

Inpatient & Outpatient Medications

Complications

  • Systemic - Nephrocalcinosis, pulmonary fibrosis, and cardiac dysrhythmias
  • Ocular - Band keratopathy, cataracts, glaucoma, cystoid macular edema (CME), vitreous hemorrhage, retinal detachment, and blindness from macular lesions
  • Neuro-ophthalmologic - Diplopia and optic atrophy
  • Neurosarcoid - Seizures, hydrocephalus, deafness, motor/sensory deficits from spinal lesions, and pituitary dysfunction

Prognosis

  • Prognosis of sarcoidosis is highly variable. Spontaneous remissions occur in nearly two thirds of systemic disease. The course may be chronic or progressive in 10-30%.
  • Ocular involvement is similarly variable. In general, acute iritis, hilar adenopathy, and erythema nodosum tend to have a benign self-limiting course. Chronic uveitis, glaucoma, and CME bode poorly. Fundus lesions have an increased incidence of associated neurosarcoidosis.
  • Neurosarcoid
    • In general, neurosarcoid carries a poorer prognosis than any of the protean manifestations of the disease. Of all deaths due primarily to sarcoidosis, 25% occur in patients with CNS localization.
    • Lesions involving the spinal cord, optic nerve lesions, and seizures carry a poor prognosis, while facial nerve pareses fare better.
    • The prognosis of sarcoid meningitis was excellent in Chapelon's series.5 Approximately two thirds of the patients with cranial neuropathy or CNS involvement recovered without deficit. Peripheral polyneuropathy and myopathy had a less favorable prognosis.
  • Adverse prognostic factors include lupus pernio, chronic uveitis, age older than 40 years at onset, chronic hypercalcemia, nephrocalcinosis, black race, progressive pulmonary sarcoidosis, nasal mucosal involvement, cystic bone lesions, neurosarcoidosis, myocardial involvement, and chronic respiratory insufficiency.

Miscellaneous

Medicolegal Pitfalls

  • Diagnosis: Ocular involvement (particularly uveitis) and neurosarcoid may be difficult to diagnose. A high level of suspicion and periodic retesting may be warranted when the initial workup is negative.
  • Treatment
    • Discuss corticosteroid and/or immunosuppressive adverse effects in detail with the patient. The risks, benefits, and alternatives of chronic immunosuppression must be properly documented.
    • Check tuberculosis (TB) skin test and controls prior to initiation of corticosteroid therapy.
    • Appropriate and timely treatment may avoid chronic CME, a common cause of visual disability.
 


More on Sarcoidosis

Overview: Sarcoidosis
Differential Diagnoses & Workup: Sarcoidosis
Treatment & Medication: Sarcoidosis
Follow-up: Sarcoidosis
References
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Further Reading

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Keywords

sarcoidosis, ocular sarcoidosis, sarcoid, ocular sarcoid, neurosarcoid, neurosarcoidosis, granulomatous disease, noncaseating epithelioid granuloma, granulomata, Boeck disease, Boeck’s disease, Boeck's sarcoid, Hutchinson disease, Hutchinson’s disease

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Contributor Information and Disclosures

Author

Andrew A Dahl, MD, Director of Ophthalmology Teaching, Mid-Hudson Family Practice Institute, The Institute for Family Health; Assistant Professor of Surgery (Ophthalmology), New York College of Medicine
Andrew A Dahl, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

L Raymond DeBarge, MD, Assistant Professor, Department of Ophthalmology, University of Tennessee College of Medicine at Chattanooga
L Raymond DeBarge, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Physicians, American Medical Association, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Medical Editor

John D Sheppard Jr, MD, MMSc, Professor of Ophthalmology, Microbiology and Molecular Biology, Clinical Director, Thomas R Lee Center for Ocular Pharmacology, Program Director, Ophthalmology Residency Training, Eastern Virginia Medical School; President, Virginia Eye Consultants
John D Sheppard Jr, MD, MMSc is a member of the following medical societies: American Academy of Ophthalmology, American Society for Microbiology, American Society of Cataract and Refractive Surgery, American Uveitis Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

R Christopher Walton, MD, Professor, Director of Uveitis and Ocular Inflammatory Disease Service, Department of Ophthalmology, Assistant Dean for Graduate Medical Education, University of Tennessee College of Medicine; Consulting Staff, Regional Medical Center, Memphis Veterans Affairs Medical Center, St Jude Children's Research Hospital
R Christopher Walton, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Healthcare Executives, American Uveitis Society, Association for Research in Vision and Ophthalmology, and Retina Society
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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