A 23-year-old man presented with a 2-day history of decreased vision and distortion in his right eye. His visual acuities were 20/50 OD and 20/20 OS. He had a right relative afferent pupillary defect and normal appearing anterior segments in both eyes. A dilated fundus examination revealed vitritis, bilateral optic disc edema (Figure 1), and retinal periphlebitis causing a branch vein occlusion (Figure 2). He was admitted to the hospital for intravenous corticosteroid therapy and evaluation for retinal vasculitis. Magnetic resonance imaging of the patient's brain revealed no masses, and lumbar puncture findings showed a mildly elevated opening pressure of 220 mm of water and mild pleocytosis without evidence of infection. A chest radiograph (Figure 3) showed bilateral hilar lymphadenopathy. The patient's angiotensin-converting enzyme level was elevated at 0.086 U/L (normal, <0.04 U/L). A lymph node biopsy specimen obtained by mediastinoscopy revealed granulomatous inflammation, confirming the diagnosis of sarcoidosis. The patient responded well to treatment with systemic corticosteroids, and despite complication of retinal neovascularization requiring laser treatment, the vision in his right eye remains stable at 20/20.
Thorne JE, Galetta SL. Disc Edema and Retinal Periphlebitis as the Initial Manifestation of Sarcoidosis. Arch Neurol. 1998;55(6):862-863. doi:10.1001/archneur.55.6.862