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July 1981

Ocular Sarcoidosis

Arch Ophthalmol. 1981;99(7):1193. doi:10.1001/archopht.1981.03930020067002

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When a patient has a granulomatous uveitis and investigations reveal an anergy to tuberculin, an enlargement of the hilar glands on chest x-ray film, and raised serum immunoglobulin levels, a diagnosis of sarcoidosis can be made with confidence. Histological confirmation from a biopsy of a lymph node or the conjunctiva is hardly necessary in such cases.

However, when the ocular findings are less typical, as for example in lesions of the optic disc (see p 1194) or of the lacrimal sac (see p 1198) and when the typical roentgenographic findings are absent, the diagnosis of sarcoidosis requires further evidence.

The Kweim-Siltzbach test is positive in 80% of cases of sarcoidosis and is easy to perform, but it does necessitate the use of a potent antigen that is not commercially available and has to be obtained from the spleen of a patient with active sarcoidosis. Care must be taken to exclude

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Nosal A, Schleissner L, Mishkin F, et al:  Angiotensin converting enzyme and gallium scan in noninvasive evaluation of sarcoidosis . Ann Intern Med 1979;90:328-331.Article
Weinreb RN, O'Donnell JJ, Sandman R, et al:  Angiotensin converting enzyme in sarcoid uveitis . Invest Ophthalmol Vis Sci 1979;18:1285-1287.
Weinreb RN, Kimura SJ:  Uveitis associated with sarcoidosis and angiotensin converting enzyme . Am J Ophthalmol 1980;89:180-185.