Sarcoidosis (orbital manifestations)

Orbital manifestations of sarcoidosis is 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. 

Epidemiology

Orbital involvement in systemic sarcoidosis is common (up to 80% of patients) and anterior uveitis is the most common manifestation ^{1, 3-5}. Lacrimal glandThe manifestations may coexist with asymptomatic systemic disease and can precede systemic involvement is rare ⁶by several years. 

Clinical presentation 

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. 

Pathology

Histopathological analysis of the biopsied lacrimal glands reveals diffuse chronic granulomatous inflammation with non-caseating granulomas.

Radiographic features

There is no real indication for imaging studies in patients with known sarcoidosis ⁶. 

CT/MRI

• 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.

Differential diagnosis

• lacrimal gland
  • lymphoma of lacrimal gland: both are radiologically indistinguishable