From the Guidelines
Sarcoidosis can cause significant morbidity in the eyes and muscles, leading to complications such as uveitis, granulomatous myositis, and cardiac muscle involvement, which can result in permanent vision loss, muscle weakness, and heart failure if left untreated. In the eyes, sarcoidosis commonly causes uveitis (inflammation of the uvea), which may present as redness, pain, light sensitivity, and blurred vision, as well as dry eyes, conjunctival nodules, retinal vasculitis, optic nerve inflammation, and in severe cases, glaucoma or cataracts 1. For muscles, sarcoidosis can cause granulomatous myositis, resulting in muscle weakness, pain, and tenderness, particularly in the larger muscle groups, and cardiac muscle involvement can lead to arrhythmias or heart failure.
Key Complications
- Uveitis
- Granulomatous myositis
- Cardiac muscle involvement
- Dry eyes
- Conjunctival nodules
- Retinal vasculitis
- Optic nerve inflammation
- Glaucoma
- Cataracts Treatment typically involves corticosteroids like prednisone (starting at 20-40mg daily), often tapered over months, with steroid-sparing agents such as methotrexate (10-25mg weekly) or hydroxychloroquine added for long-term management, as recommended by the European Respiratory Journal 1. Regular ophthalmologic examinations are essential for patients with sarcoidosis, even without eye symptoms, as early detection and treatment of ocular involvement can prevent permanent damage. Additionally, patients with sarcoidosis-associated fatigue may benefit from a pulmonary rehabilitation programme and/or inspiratory muscle strength training for 6–12 weeks to improve fatigue, as suggested by the guideline recommendations 1.
From the Research
Effects of Sarcoidosis on Eyes
- Sarcoidosis is one of the leading causes of inflammatory eye disease, and any part of the eye and its adnexal tissues can be involved 2, 3.
- The main manifestations of ocular sarcoidosis are uveitis and optic neuropathy 2, 3, 4.
- Uveitis can be chronic posterior uveitis, and optic neuropathy often affects women of African and Caribbean origin 2, 3.
- Clinically isolated uveitis revealing sarcoidosis remains a strictly ocular condition in a large majority of cases, but it can be a serious condition involving functional prognosis 2, 3.
Treatment of Ocular Sarcoidosis
- Systemic corticosteroids are indicated when uveitis does not respond to topical corticosteroids or when there is bilateral posterior involvement, especially macular edema and occlusive vasculitis 2, 3, 5.
- Additional immunosuppression, including methotrexate, azathioprine, and mycophenolate mofetil, is used in up to 25-30% of cases that require an unacceptable dosage of corticosteroids to maintain remission 2, 3, 5.
- Infliximab and adalimumab have been successfully used for the treatment of refractory or sight-threatening disease 2, 5.
- Mycophenolate mofetil (MMF) is effective in controlling sarcoidosis-related ocular inflammation, has a corticosteroid sparing effect, and a manageable side-effect profile 6.
Effects of Sarcoidosis on Muscles
- There is no direct evidence in the provided studies regarding the effects of sarcoidosis on muscles.