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Orbital and Adnexal Sarcoidosis
Venkatesh C. Prabhakaran, MS, MRCOphth;
Perooz Saeed, MD;
Bita Esmaeli, MD;
Timothy J. Sullivan, FRANZCO;
Alan McNab, MD, FRANZCO;
Garry Davis, FRANZCO;
Alejandra Valenzuela, MD;
Igal Leibovitch, MD;
Anat Kesler, MD;
Jennifer Sivak-Callcott, MD;
Erika Hoyama, MD;
Dinesh Selva, FRANZCO
Arch Ophthalmol. 2007;125(12):1657-1662.
Objective To present the clinical features and management in a series of patients with orbital and adnexal sarcoidosis.
Methods This multicenter retrospective study included patients with biopsy-proven noncaseating granuloma involving the orbit or adnexa and evidence of systemic sarcoidosis. Clinical records were reviewed for initial examination findings, radiological findings, treatment modalities, and outcome.
Results The study included 26 patients (19 female, 7 male; mean age, 52 years). The most common feature at the first examination was a palpable periocular mass followed by discomfort, proptosis, ptosis, dry eye, diplopia, and decreased vision. The disease affected the lacrimal gland (42.3%), orbit (38.5%), eyelid (11.5%), and lacrimal sac (7.7%). Among orbital lesions, the antero-inferior quadrant was preferentially involved. Treatment modalities included steroids, surgical debulking, and methotrexate. During a mean follow-up of 18.75 months, 84.6% of patients showed a complete response to the treatment, but 19.2% of patients developed further signs of sarcoidosis.
Conclusions Orbital soft tissue involvement is more common in patients older than 50 years and in women. The anterior inferior quadrants of the orbits appear to be preferentially affected. Although a good response to treatment with oral steroids is seen, long-term follow-up is recommended because active systemic disease can develop months to years later.
Author Affiliations: South Australian Institute of Ophthalmology and Department of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, Australia (Drs Prabhakaran, Davis, Hoyama, and Selva); Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands (Dr Saeed); Section of Ophthalmology, M. D. Anderson Cancer Center, Houston, Texas (Dr Esmaeli); Department of Ophthalmology, Royal Brisbane Hospital, Brisbane, Australia (Mr Sullivan and Dr Valenzuela); Royal Victoria Eye and Ear Hospital, Melbourne, Australia (Dr McNab); Department of Ophthalmology, Tel Aviv Medical Center, University of Tel Aviv, Tel Aviv, Israel (Drs Leibovitch and Kesler); and Department of Ophthalmology, West Virginia University School of Medicine, Morgantown (Dr Sivak-Callcott).
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