Clinical and Ophthalmological Characteristics and Therapeutic Management of Patients With Sarcoidosis.

Abstract

Objective This study aimed to describe the clinical and ophthalmological characteristics, therapeutic management, and visual outcomes of patients with sarcoidosis at a tertiary referral center in Mexico over 10 years. Patients and methods This retrospective case series included patients diagnosed with sarcoidosis between 2015 and 2025 at Centro Médico Nacional "20 de Noviembre." Diagnosis was based on clinical, radiological, and histopathological criteria aligned with the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) and the International Workshop on Ocular Sarcoidosis (IWOS) guidelines. Patients with complete records and at least one ophthalmologic evaluation were included. Data on demographics, systemic and ocular involvement, comorbidities, and treatments were collected and analyzed descriptively. Results Eight patients (75% female; median age: 67 years) were included, reflecting the rarity of sarcoidosis in our setting. Ocular involvement was present in five patients (62.5%). Keratoconjunctivitis sicca (KCS) was the most common manifestation, affecting four patients (50%), all bilaterally. Two patients (25%) presented with bilateral non-granulomatous anterior uveitis, one of whom progressed to panuveitis with peripheral chorioretinal lesions and uveitic macular edema. An asymptomatic solitary choroidal granuloma was identified in one patient (12.5%) through clinical examination and optical coherence tomography (OCT)-enhanced depth imaging (EDI). Visual acuity (VA) was assessed only in the five patients who underwent ophthalmologic evaluation; the remaining three were not assessed, as ophthalmologic consultation was not requested, likely due to the absence of ocular symptoms at presentation. Among evaluated patients, 37.5% had normal visual acuity, 25% had mild impairment, and one patient (12.5%) had severe visual loss. All patients received corticosteroids: 87.5% systemically and 25% via topical, periocular, or intravitreal routes. Immunosuppressive therapy was used in 75% (50% methotrexate, 25% azathioprine), and one patient (12.5%) received biologic therapy (adalimumab). Follow-up ranged from three to 10 years (median: five years), with two patients currently under active treatment for ocular sarcoidosis after three years of follow-up. Conclusions Ocular involvement was common in our cohort and, in some cases, represented the initial manifestation of sarcoidosis. KCS was the most frequently observed ocular finding. While quantitative VA data were limited, most evaluated patients maintained good visual function. Systemic corticosteroids were the mainstay of treatment, with immunosuppressants and biologics reserved for refractory cases. Given the potential for asymptomatic ocular disease, routine ophthalmologic evaluation is recommended for all patients with sarcoidosis, regardless of the presence of ocular symptoms.