A 31-YEAR-OLD African American woman had a 5-day history of blurred vision in the left eye. Her visual acuity was 20/20 OD and 20/25 OS. Examination revealed a few 1- to 2-mm conjuctival nodules in the left eye. Results of slitlamp examination and intraocular pressure testing were normal. Ophthalmoscopy results were normal on the right, but on the left a 1-mm vascularized lesion was present superior to the optic disc (Figure 1). A chest x-ray film demonstrated bilateral hilar adenopathy (Figure 2). The patient did not return for follow-up until 2 months later, at which time she complained of further decreased vision. Her visual acuity was 20/20 OD and 20/400 OS. The mass over the disc had enlarged substantially (Figure 3). A conjunctival biopsy specimen revealed noncaseating granuloma, confirming the diagnosis of sarcoidosis (Figure 4). The patient was started on a regimen of oral prednisone at a dosage of 60 mg/d. After the lesion shrank, prednisone was tapered over 6 months. Eighteen months after the patient stopped prednisone therapy, examination revealed a visual acuity of 20/20 OD and 20/25 OS with a gliotic remnant of the mass remaining (Figure 5).
Farr AK, Jabs DA, Green WR. Optic Disc Sarcoid Granuloma. Arch Ophthalmol. 2000;118(5):728-729. doi:10.1001/archopht.118.5.728