Pediatric ocular sarcoidosis

doi:10.1016/0039-6257(86)90118-9

Survey of Ophthalmology

Volume 30, Issue 4, January–February 1986, Pages 215-228

https://doi.org/10.1016/0039-6257(86)90118-9 Get rights and content

Abstract

Sarcoidosis is an uncommon cause of childhood uveitis. However, the ophthalmologist familiar with the clinical features of childhood sarcoidosis can play a key role in the diagnosis and treatment of this disorder. Two subsets of pediatric sarcoidosis are identified. The 8–15 year age group has almost universal lung involvement, with the eye, skin, liver, and spleen involved in 30–40% of cases. Children 5 years of age and under are characterized by the triad of uveitis, arthropathy, and skin rash. The epidemiology, clinical features, diagnostic evaluation, and ocular management of pediatric sarcoidosis are reviewed. The clinical and laboratory findings that distinguish sarcoidosis from other causes of childhood uveitis are discussed.

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Cited by (91)

Sarcoidosis diagnosis based on ocular involvement. Case report
2024, Revista Colombiana de Reumatologia
La sarcoidosis es una enfermedad multisistémica de causa desconocida, secundaria a una reacción inmunitaria determinada genéticamente y desencadenada por factores ambientales, que conlleva la formación de granulomas no caseosos. El compromiso ocular es el segundo más frecuente después del pulmonar. El hallazgo más común es la uveítis granulomatosa anterior; también se puede evidenciar uveítis posterior, periflebitis retiniana, coriorretinitis, conjuntivitis, escleritis y neuritis óptica. Describimos el caso de una paciente pediátrica con una enfermedad de compromiso multisistémico de larga data, en quien la demostración de granulomas no caseificantes en la biopsia conjuntival permitió establecer el diagnóstico presuntivo de sarcoidosis.
Sarcoidosis is a multisystemic disease of unknown cause, secondary to a genetically determined immune reaction triggered by environmental factors, which leads to the formation of non-caseating granulomas. Ocular involvement is the second most frequent after pulmonary involvement. The most common finding is anterior granulomatous uveitis, but posterior uveitis, retinal peri-phlebitis, chorioretinitis, conjunctivitis, scleritis and optic neuritis can also be seen. We describe the case of a paediatric patient with long-standing multisystem involvement disease, in whom the demonstration of non-caseating granulomas in the conjunctival biopsy allowed a presumptive diagnosis of sarcoidosis.
Whitcup and Nussenblatt’s Uveitis: Fundamentals and Clinical Practice
2021, Whitcup and Nussenblatt's Uveitis: Fundamentals and Clinical Practice
Multisystem diseases affecting the skin and eye
2016, Clinics in Dermatology
Citation Excerpt :
Sarcoidosis can affect multiple parts of the eye, including cutaneous involvement of the lid and orbital rim, granulomatous inflammation of the eye itself, infiltration of the lacrimal glands, and sarcoidal involvement of the optic nerve and central nervous system (CNS). Sarcoidosis may present initially in the eye; ocular sarcoidosis can lead to severe visual impairment and warrants thorough assessment, and, if present, targeted treatment.91,92 Uveitis is the most common ocular manifestation of sarcoidosis, and sarcoidosis accounts for 3-7% of all cases of uveitis.93
There exist a wide variety of multisystem diseases that can affect both the eyes and skin. The skin and eyes may be the initial sites affected, leading to a new diagnosis of a systemic illness, or severe skin and eye involvement can drive treatment for patients with multisystem disease. It is important for physicians to be aware of how to recognize and diagnose these conditions, to evaluate patients for extent of disease, and to initiate appropriate therapies to combat these potentially severe diseases. This contribution will discuss the following diseases with a special emphasis on the mucocutaneous and ophthalmologic manifestations: reactive arthritis, sarcoidosis, necrobiotic xanthogranuloma and other granulomatous diseases, amyloidosis, Behçet disease, cholesterol emboli, Vogt-Koyanagi-Harada syndrome, and the primary vasculitides. In each case, a thorough understanding of the cutaneous manifestations and ocular manifestations are critical to help guide appropriate evaluation of these patients, and managing the ocular and cutaneous manifestations are critical to prevent morbidity and potentially devastating long-term sequelae.
Inflammatory disorders
2016, Taylor and Hoyt's Pediatric Ophthalmology and Strabismus, Fifth Edition
Ocular Sarcoidosis
2015, Clinics in Chest Medicine
Citation Excerpt :
In patients with systemic sarcoidosis, females (56%) were more likely to develop ocular involvement compared with males (23%) in a study of 121 patients with biopsy-proven sarcoidosis.6 Sarcoidosis reportedly may affect children, and most of these cases begin between the ages of 8 and 15 years.7 Many patients, however, previously diagnosed as having early-onset sarcoidosis are now recognized as having Blau syndrome with de novo mutations.8
Granulomatous inflammation: The overlap of immune deficiency and inflammation
2014, Best Practice and Research: Clinical Rheumatology
Citation Excerpt :
It is not unusual for sarcoidosis to be diagnosed by an ophthalmologist who will consult rheumatology in order to both confirm and determine the extent of involvement of the disease. Patients with sarcoidosis seek ophthalmology care due to either ocular or orbital symptoms [20,21]. Overall, about one of three of children with sarcoidosis will experience eye disease at some point in the course as shown in the Danish national registry [11].
Pediatric granulomatous diseases constitute a heterogenous group of conditions in terms of clinical phenotypes, pathogenic mechanisms, and outcomes. The common link is the presence of multinucleated giant cells in the inflammatory infiltrate. The clinical scenario in which a tissue biopsy shows granulomatous inflammation is not an uncommon one for practicing adult and pediatric rheumatologists. Our role as rheumatologists is to develop a diagnostic plan based on a rational differential diagnostic exercise tailored to the individual patient and based mainly on a detailed clinical assessment.
This chapter presents a comprehensive differential diagnosis associated with a classification developed by the authors. We describe with some detail extrapulmonary sarcoidosis, Blau syndrome, and immunodeficiency associated granulomatous inflammation, which in our view are the paradigmatic primary forms of granulomatous diseases in childhood. The other entities are presented only as differential diagnoses listing their most relevant clinical features.
This chapter shows that almost all granulomatous diseases seen in adults can be found in children and that there are some entities that are essentially pediatric at onset, namely Blau syndrome and most forms of immunodeficiency associated granulomatous diseases.

View all citing articles on Scopus

^☆: Supported in part by a grant from Research to Prevent Blindness, Inc.

View full text

ReviewPediatric ocular sarcoidosis☆

Abstract

Ophthalmology

J Pediatr

Ophthalmology

J Pediatr

Am J Ophthalmol

Ophthalmology

Am J Ophthalmol

Hum Pathol

J Pediatr

Am J Ophthalmol

Chest

Chest

J Am Acad Derm

Clin Rheum Dis

Otolaryngol Clin N Am

Adv Pediatr

Ophthalmology

Am J Med

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

J Pediatr

Am J Ophthalmol

Surv Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Sarcoidosis in a young child

Epidemiology of sarcoidosis

Epidemiol Rev

Current proposed revision of JRA criteria

Arthritis Rheum

Familial associations in sarcoidosis

Tubercle

Arthroscopic examination of the knee joint

Arch Surg

Filtering surgery in childhood glaucoma

Ophthal Surg

Clinical features of Still's disease — a general review and report of 100 patients observed for 15 years

Sarcoidosis. Report of a case of a child simulating Still's Disease

Am J Dis Child

The ocular manifestations of juvenile rheumatoid arthritis

Arthritis Rheum

Sarcoidosis and ocular disease in a young child

Arch Ophthalmol

Sarcoidosis in the United States Army, 1952 through 1956

Am Rev Respir Dis

Serum angiotensin-converting enzyme activity in evaluating the clinical course of sarcoidosis

Ann Int Med

Lensectomy and vitrectomy for complicated cataract secondary to uveitis

Arch Ophthalmol

Band-shaped keratitis in juvenile rheumatoid arthritis

Acta Rheum Scand

(Discussion) Conjunctival biopsy as an aid in the evaluation of the patient with suspected sarcoidosis

Ophthalmology

Unusual causes of episcleritis

Trans Am Acad Ophthalmol Otolaryngol

The effect of preoperative subconjunctival triamcinolone on glaucoma filtration

Panuveitis — presenting symptom of systemic sarcoidosis in a child

J Pediatr Ophthalmol

Sarcoidosis

Systemic and Neuro-sarcoidosis in a child

Indian Pediatr

Review
Pediatric ocular sarcoidosis☆