Orbital and adnexal sarcoidosis.
OBJECTIVE
To present the clinical features and management in a series of patients with orbital and adnexal sarcoidosis.


METHODS
This multicenter retrospective study included patients with biopsy-proven noncaseating granuloma involving the orbit or adnexa and evidence of systemic sarcoidosis. Clinical records were reviewed for initial examination findings, radiological findings, treatment modalities, and outcome.


RESULTS
The study included 26 patients (19 female, 7 male; mean age, 52 years). The most common feature at the first examination was a palpable periocular mass followed by discomfort, proptosis, ptosis, dry eye, diplopia, and decreased vision. The disease affected the lacrimal gland (42.3%), orbit (38.5%), eyelid (11.5%), and lacrimal sac (7.7%). Among orbital lesions, the antero-inferior quadrant was preferentially involved. Treatment modalities included steroids, surgical debulking, and methotrexate. During a mean follow-up of 18.75 months, 84.6% of patients showed a complete response to the treatment, but 19.2% of patients developed further signs of sarcoidosis.


CONCLUSIONS
Orbital soft tissue involvement is more common in patients older than 50 years and in women. The anterior inferior quadrants of the orbits appear to be preferentially affected. Although a good response to treatment with oral steroids is seen, long-term follow-up is recommended because active systemic disease can develop months to years later.
Prabhakaran
Venkatesh C
VC
South Australian Institute of Ophthalmology and Department of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, Australia. eye@health.sa.gov.au
Saeed
Perooz
P
Esmaeli
Bita
B
Sullivan
Timothy J
TJ
McNab
Alan
A
Davis
Garry
G
Valenzuela
Alejandra
A
Leibovitch
Igal
I
Kesler
Anat
A
Sivak-Callcott
Jennifer
J
Hoyama
Erika
E
Selva
Dinesh
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003646:Debridement; D005141:Eyelid Diseases / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007766:Lacrimal Apparatus Diseases / Q000175:diagnosis* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D009916:Orbital Diseases / Q000175:diagnosis* / Q000628:therapy; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000175:diagnosis* / Q000628:therapy; D014057:Tomography, X-Ray Computed
D005938:Glucocorticoids