Background/Purpose: Sarcoidosis is a multisystemic inflammatory disease of unknown origin characterized by non-caseating epitheliod granulomas that can affect any organ system. The three most frequency affected organs are lung, skin and eyes. Ocular involvement is the presenting symptom in approximately 20-30% and can involve any part of the eye and its anexal tissues. Sarcoidosis may cause uveitis, conjunctivitis, episcleritis/scleritis, optical nerve disease and orbital inflammation. The aim of this study was to analyze the prevalence of ocular involvement in systemic sarcoidosis in the population of Cantabria (Spain), the clinical patterns and their correlation with the IWOS criteria.

Methods: Retrospective study of patients admitted to a single reference University Hospital between 2004 and 2017 with diagnosis of sarcoidosis. Clinical findings, demographics features, anatomic location and IWOS intraocular signs were recorded. We also collected serum angiotensin converting enzyme (ACE), liver enzyme test, chest radiography, chest computed tomography scan (CT), treatment and biopsy if it was performed.

Results: We included 262 patients with diagnosis of sarcoidosis. Most of the cases were women (59%) with a median age of 44 years. The most affected organ was lung (79%), followed by skin (25%) and eye (12.2%). Thirty-two patients had ocular symptoms due to sarcoid disease and 29 of them had uveitis. There were 27 patients (84.4%) who met one of the 4 IWOS ocular sarcoidosis diagnostic categories: 15 with definite (46.9%), 9 presumed (28.1%) and 3 with posible (9.4%) sarcoidosis. Five patients did not meet IWOS criteria. The most common ocular signs were bilaterality (55.2%), snowballs or strings of pearls (51.7%), mutton-fat KPs (31%), multiple chorioretinal peripheral lesions (20.7%) and periphlebitis (13.8%). ACE increase was observed in 23% of patients with ocular sarcoidosis with a median value of 75.9. Ninety three percent of patients received oral corticosteriods, 17 a conventional inmunosupresor and 5 a biological treatment.

Conclusion: The eye is the third organ of sarcoidosis involvement. Although there is no gold standar for diagnosing ocular sarcoidosis yet, IWOS signs can help clinicians suspect it. However, there seem to be some limitations.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/ocular-and-systemic-features-in-262-patients-with-systemic-sarcoidosis-and-its-correlation-with-iwos-criteria/