Pao Shu-I, Chang Yun-Hsiang, Hsu Chih-Kang, Lu Da-Wen
Department of Ophthalmology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan.
Taiwan J Ophthalmol. 2016 Jan-Mar;6(1):45-51. doi: 10.1016/j.tjo.2015.02.001. Epub 2015 Apr 3.
Anterior uveitis is the most common ocular manifestation of sarcoidosis. Ocular involvement affects approximately 30-60% of patients with systemic sarcoidosis; however, optic disc edema is a rare event. We report a patient who presented with a rare case of sarcoidosis with neuro-ophthalmic manifestations.
A 22-year-old man was referred to our clinic with the primary complaint of a visual field defect over the temporal side of his right eye of 2 months duration. He did not have a history of systemic disease. At the first ophthalmic examination, the visual acuity, intraocular pressure, and slit lamp examination were normal. The fundus examination revealed bilateral optic disc edema. He was initially suspected of having a choroidal lesion between the disc and fovea of the right eye. To evaluate the possible lesion, the patient underwent brain magnetic resonance imaging (MRI), chest radiography, and chest computed tomography (CT). There were no abnormalities on the brain MRI, but the chest radiographs and CT images revealed bilateral mediastinal and hilar lymphadenomegaly. Histopathologic evaluation of an ultrasound-guided lymph node biopsy confirmed the diagnosis of sarcoidosis.
Neuro-ophthalmic manifestations of sarcoidosis are rare but may be the only presenting sign of an otherwise occult disease. A high clinical suspicion for sarcoidosis and its inclusion as a differential diagnosis are key to establishing the diagnosis and proper treatment.
前葡萄膜炎是结节病最常见的眼部表现。眼部受累在系统性结节病患者中约占30 - 60%；然而，视盘水肿是一种罕见情况。我们报告一例出现结节病伴神经眼科表现的罕见病例。
一名22岁男性因右眼颞侧视野缺损2个月的主要诉求转诊至我院门诊。他无全身性疾病史。首次眼科检查时，视力、眼压及裂隙灯检查均正常。眼底检查发现双侧视盘水肿。最初怀疑他右眼视盘与黄斑之间有脉络膜病变。为评估可能的病变，患者接受了脑部磁共振成像（MRI）、胸部X线摄影及胸部计算机断层扫描（CT）检查。脑部MRI未发现异常，但胸部X线片和CT图像显示双侧纵隔及肺门淋巴结肿大。超声引导下淋巴结活检的组织病理学评估确诊为结节病。
结节病的神经眼科表现罕见，但可能是隐匿性疾病的唯一表现体征。对结节病保持高度临床怀疑并将其纳入鉴别诊断，是确立诊断和进行恰当治疗的关键。
