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Journal of Peking University (Health Sciences) ›› 2025, Vol. 57 ›› Issue (6): 1061-1066. doi: 10.19723/j.issn.1671-167X.2025.06.007

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Clinical features and prognosis of sarcoidosis with ocular lesions as the initial manifestation

Jiajing PENG, Li CUI*()   

  1. Department of Rheumatology and Immunology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
  • Received:2025-10-17 Online:2025-12-18 Published:2025-10-28
  • Contact: Li CUI

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Abstract:

Objective: To evaluate the clinical features of sarcoidosis with ocular lesions as the initial manifestation and to analyze its treatment and prognostic outcomes. Methods: A retrospective study was conducted to evaluate the clinical data of sarcoidosis patients from July 2010 to July 2025 in the Department of Rheumatology and Immunology, Beijing Tongren Hospital. Results: Among the 23 patients, the male-to-female ratio was 1 ∶ 2.3, with a mean age of (45.1±14.1) years, a median disease duration of 0.5 (0.25, 1.50) years, and a median diagnosis time of 0.5 (0.20, 1.00) years. Fourteen patients presented with ocular lesions as the initial manifestations, while 9 patients had non-ocular lesions (such as respiratory system involvement or joint swelling/pain) as the initial manifestations. The most common ocular lesions were non-infectious uveitis and orbital masses. Orbital masses were most commonly encountered as lacrimal gland enlargement. Other ocular lesions included optic neuritis and optic perineuritis. The median follow-up time was 21.21 (5.00, 147.29) months. Following treatment, all the patients achieved significant clinical improvement, of whom 3 patients with non-infectious uveitis and 1 with optic perineuritis showed improved visual acuity and overall visual function. During the follow-up period, 2 patients with sarcoidosis experienced disease recurrence. After their treatment regimens were reinitiated, both patients achieved remission with a favorable prognosis. Compared with the patients with non-ocular-onset as the initial manifestation, the patients with ocular-onset as the initial manifestation had a significantly longer diagnosis time, and the difference was statistically significant (P =0.025). The C-reactive protein (CRP) level was 1.90 (0.50, 4.62) mg/L in the ocular-onset group and 11.70 (0.90, 31.45) mg/L in the non-ocular-onset group, and the difference was statistically significant (P =0.042). The erythrocyte sedimentation rate (ESR) was 14.00 (8.50, 24.00) mm/h in the ocular-onset group and 26.00 (15.50, 47.00) mm/h in the non-ocular-onset group, and the difference was statistically significant (P =0.033). The ocular-onset group had significantly lower levels of both CRP and ESR compared with the non-ocular-onset group. Conclusion: Sarcoidosis with ocular-onset as the initial manifestation poses diagnostic challenges, as routine inflammatory markers have limited utility in suggesting the disease and thus it is easily overlooked. Therefore, enhancing clinicians' ability to recognize these ocular-onset features is crucial for achieving early diagnosis and enabling timely intervention.

Key words: Sarcoidosis, Non-infectious uveitis, Lacrimal gland enlargement

CLC Number: 

  • R593.2

Figure 1

Fundus fluorescein angiography of bilateral non-infectious uveitis in sarcoidosis Fundus fluorescein angiography reveals bilateral peripheral capillary leakage. A, right eye; B, left eye."

Figure 2

Orbital magnetic resonance imaging of lacrimal gland enlargement in sarcoidosis Orbital magnetic resonance imaging demonstrates bilateral lacrimal gland enlargement with anterior displacement, exhibiting mildly hypointense signal on T1-weighted imaging (A) and hyperintense signal on T2-weighted imaging (B), with marked enhancement post-contrast administration (C)."

Figure 3

Orbital magnetic resonance imaging of optic perineuritis in sarcoidosis Orbital magnetic resonance imaging shows enhancement of the sheath in the posterior intraorbital segment and intracanalicular segment of the left optic nerve."

Table 1

Clinical characteristics in sarcoidosis patients with ocular-onset or non-ocular-onset as the initial manifestation"

Items Ocular-onset (n=14) Non-ocular-onset (n=9) P value
Female, n(%) 7 (50) 9 (100) 0.019
Age/years, $\bar x \pm s$ 45.00±15.84 45.22±11.71 0.972
Age of onset/years, $\bar x \pm s$ 42.54±15.22 44.68±11.57 0.722
CRP/(mg/L), M (P25，P75) 1.90 (0.50, 4.62) 11.70 (0.90, 31.45) 0.042
ESR/(mm/h), M (P25，P75) 14.00 (8.50, 24.00) 26.00 (15.50, 47.00) 0.033
ACE/(U/L), $\bar x \pm s$ 37.36±18.33 44.33±24.95 0.448
IgG/(mg/dL), $\bar x \pm s$ 1 196.48±249.65 1 283.44±395.03 0.544
IgA/(mg/dL), $\bar x \pm s$ 218.69±107.86 275.86±127.95 0.281
IgM/(mg/dL), $\bar x \pm s$ 103.64±43.97 135.76±56.38 0.158
Complement C3/(mg/dL), $\bar x \pm s$ 110.08±31.11 134.39±25.73 0.077
Complement C4/(mg/dL), $\bar x \pm s$ 27.34±11.23 31.02±7.46 0.412
Duration/years, M (P25，P75) 1.00 (0.36, 4.25) 0.50 (0.23, 0.75) 0.092
Time to diagnosis/years, M (P25，P75) 1.00 (0.36, 1.50) 0.20 (0.10, 0.75) 0.025
Follow-up time/months, M (P25，P75) 24.23 (2.78, 148.42) 12.54 (10.15, 122.34) 0.801
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