Sarcoidosis (orbital manifestations)

Last revised by Dr Mohamed Saber on 19 Mar 2021

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 characterized 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

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 

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Cases and figures

  • Case1: bilateral enlargement of lacrimal glands
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  • Case 2: periorbital sarcoidosis
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