Orbital manifestations of sarcoidosis are common among patients with systemic sarcoidosis and can involve the lacrimal gland, the orbit, soft tissues of the orbit, and the optic nerve. Uveitis is by far the most common manifestation and is typically bilateral 5.
For a general discussion of the underlying condition, please refer to the article sarcoidosis.
Orbital involvement in systemic sarcoidosis is common (up to 80% of patients) and anterior uveitis is the most common manifestation 1, 3-5. The manifestations may coexist with asymptomatic systemic disease and can precede systemic involvement by several years.
Anterior uveitis has a rapid onset of symptoms characterised by blurred vision, photophobia, and excessive lacrimation 3.
Conjunctival involvement with small, pale, yellow nodules is frequently present 3.
Histopathological analysis of the biopsied lacrimal glands reveals diffuse chronic granulomatous inflammation with non-caseating granulomas.
There is no real indication for imaging studies in patients with known sarcoidosis 6.
- lacrimal gland
- contrast-enhanced CT or MR imaging typically demonstrates enlarged, asymmetric, enhancing lacrimal glands 5
- the glands typically present hypointensity both in T1 and T2 6
Treatment and prognosis
The manifestations can be self-limited or chronic, with episodic recrudescence and remissions 3. Acute uveitis usually resolves spontaneously or responds to local corticosteroid therapy 5.
Possible differential considerations include:
- pathologies of the lacrimal gland
- lymphoma of the lacrimal gland: both are radiologically indistinguishable
- 1. Prabhakaran VC, Saeed P, Esmaeli B et-al. Orbital and adnexal sarcoidosis. Arch. Ophthalmol. 2007;125 (12): 1657-62. doi:10.1001/archopht.125.12.1657 - Pubmed citation
- 2. Shaikh ZA, Bakshi R, Greenberg SJ et-al. Orbital involvement as the initial manifestation of sarcoidosis: magnetic resonance imaging findings. J Neuroimaging. 2000;10 (3): 180-3. Pubmed citation
- 3. Mafee MF, Dorodi S, Pai E. Sarcoidosis of the eye, orbit, and central nervous system. Role of MR imaging. Radiol. Clin. North Am. 1999;37 (1): 73-87, x. Pubmed citation
- 4. Simon EM, Zoarski GH, Rothman MI et-al. Systemic sarcoidosis with bilateral orbital involvement: MR findings. AJNR Am J Neuroradiol. 1998;19 (2): 336-7. Pubmed citation
- 5. Koyama T, Ueda H, Togashi K et-al. Radiologic manifestations of sarcoidosis in various organs. Radiographics. 2004;24 (1): 87-104. Radiographics (full text) - doi:10.1148/rg.241035076 - Pubmed citation
- 6. Vogl TJ. Differential Diagnosis in Head and Neck Imaging. Thieme. (1999) ISBN:0865778116. Read it at Google Books - Find it at Amazon