Sarcoidosis presenting as multilobular limbal corneal nodules.
OBJECTIVE
To review reported external ocular manifestations of sarcoidosis and to present bilateral, multilobular, nodular, limbal, corneal nodules as being a unique manifestation of the disease.


METHODS
A 16-year-old Saudi girl presented with bilateral, multilobular, solid, limbal nodules, with a vascular supply from the conjunctival vessel, and associated membraneous conjunctivitis and healed trachoma. The Schirmer's test revealed less than 2 mm in both eyes with tear meniscus less than 2 mm. Biopsy of an associated palpebral conjunctival nodule was performed, in addition to a gallium scan, chest X-ray, and a serum angiotensin-converting enzyme (SACE) level.


RESULTS
The culture showed beta-hemolytic streptococci. Gallium scan showed intake by both lacrimal glands. Her chest X-ray results were normal, as was the SACE level. Biopsy of the excised conjunctival nodule disclosed a noncaseating granulomatous reaction with epithelioid and giant cells, and chronic inflammatory cell infiltrate confirming a diagnosis of sarcoidosis.


CONCLUSIONS
A multilobular, nodular, perilimbal mass as a unique manifestation of sarcoidosis is presented. A streptococcal membraneous conjunctivitis and healed trachoma superimposed. A review of sarcoidosis of the external eye is included.
Hegab
S M
SM
Eye Department, Ibn-Sina Hospital, Kuwait.
al-Mutawa
S A
SA
Sheriff
S M
SM
D000293:Adolescent; D003234:Conjunctivitis, Bacterial / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D003316:Corneal Diseases / Q000150:complications / Q000175:diagnosis*; D016510:Corneal Neovascularization / Q000175:diagnosis; D003937:Diagnosis, Differential; D015352:Dry Eye Syndromes / Q000175:diagnosis; D005260:Female; D006801:Humans; D016850:Limbus Corneae / Q000473:pathology; D010406:Penicillins / Q000627:therapeutic use; D012507:Sarcoidosis / Q000150:complications / Q000175:diagnosis*; D013290:Streptococcal Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy
D010406:Penicillins