From the Guidelines
A comprehensive eye examination, including visual acuity testing, slit-lamp examination, tonometry, and dilated fundoscopic examination, is essential for patients with sarcoidosis to detect ocular involvement, which occurs in 25-50% of cases. The exam should be performed at diagnosis and periodically thereafter, even in asymptomatic patients, as ocular sarcoidosis can be silent yet progressive 1. According to the refractive errors preferred practice pattern, a comprehensive eye examination consists of an evaluation of the physiologic function and the anatomical status of the eye, visual system, and its related structures, including elements such as visual acuity, refraction, visual fields, external examination, pupillary function, ocular alignment and motility, slit-lamp biomicroscopic examination, intraocular pressure measurement, and fundus examination 1.
The slit-lamp exam is particularly important to detect anterior uveitis (iritis), which is the most common ocular manifestation of sarcoidosis. The fundoscopic exam can identify posterior segment involvement such as vitritis, retinal vasculitis, choroidal lesions, and optic nerve abnormalities. Fluorescein angiography may be needed to evaluate retinal vasculature, while optical coherence tomography can assess macular edema or optic nerve changes.
Key components of the ocular exam include:
- Visual acuity testing with current correction at distance and near
- Slit-lamp biomicroscopic examination to assess the anterior segment
- Tonometry to measure intraocular pressure
- Dilated fundoscopic examination to evaluate the posterior segment
- Assessment of relevant aspects of the patient's mental and physical status
Early detection and treatment of ocular manifestations are crucial to prevent complications like glaucoma, cataract formation, and permanent vision loss. The frequency of follow-up examinations depends on the presence and severity of ocular involvement. The American Thoracic Society recommends ophthalmology evaluation based on development of new symptoms, but additional research is needed to determine if there is a clinical benefit to routine eye exams compared with exams based on the development of symptoms 1.
From the Research
Ocular Exam Requirements in Sarcoidosis
- The diagnosis and management of ocular sarcoidosis involve various imaging techniques, including:
- A comprehensive eye examination may include:
- Special tests such as tonometry 6 and fluorescein angiography (FA) 2, 3, 4 may be obtained when indicated.
- Referral to an ophthalmologist can be made for a dilated fundus examination, ultrasound studies of the eye and orbit, and surgical treatment 5.