title: Sarcoidosis presenting as multilobular limbal corneal nodules.
abstract: 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.
authors.affiliation: Eye Department, Ibn-Sina Hospital, Kuwait.
authors.forename: S M
authors.initials: SM
authors.lastname: Hegab
authors.forename: S A
authors.initials: SA
authors.lastname: al-Mutawa
authors.forename: S M
authors.initials: SM
authors.lastname: Sheriff
mesh_terms: 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
chemical_list: D010406:Penicillins