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Brief Report
February 6, 2020

Ciliary Body Mass as a Feature of Ocular Sarcoidosis

Author Affiliations
  • 1Department of Ophthalmology and Visual Science, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor
JAMA Ophthalmol. Published online February 6, 2020. doi:10.1001/jamaophthalmol.2019.5704
Key Points

Question  How was ocular sarcoidosis associated with diffuse or segmental ciliary body mass in 3 patients with uveitis without previously known systemic sarcoidosis?

Findings  Biopsies of the ciliary body mass, identified via ultrasonographic biomicroscopy, were diagnostic of ocular sarcoidosis in the 3 patients without previously known systemic sarcoidosis.

Meaning  Diffuse or segmental ciliary body mass could be a clinical sign of ocular sarcoidosis, although the frequency of this association could not be determined from this case series.

Abstract

Importance  Ocular sarcoidosis may be the primary and only clinical manifestation of sarcoidosis, and irreversible loss of visual acuity may occur from delayed treatment. Thus, early diagnosis is imperative to preserve visual acuity. Establishing the diagnosis of sarcoidosis in cases manifesting only in the eye may require a diagnostic biopsy, which may prove challenging in the absence of available ocular surface, lacrimal gland, and systemic tissue for biopsy.

Objective  To describe diffuse or segmental ciliary body mass as a clinical sign and tissue source for biopsy in the diagnosis of ocular sarcoidosis.

Design, Setting, and Participants  This case series captures 3 cases from a university-based ocular oncology and uveitis practice. All 3 patients presented with uveitis and a diffuse or segmental ciliary body mass, which was identified via ultrasonographic biomicroscopy.

Main Outcomes and Measures  Clinical, ancillary, and histopathological ocular findings in the 3 patients.

Results  The patients were a 52-year-old white woman, a 42-year-old African American man, and an 81-year-old white man. Two individuals had unilateral involvement, and 1 had bilateral involvement. All 3 individuals presented with uveitis. Diffuse, circumferential ciliary body masses were observed in 2 patients. A localized, nodular ciliary body mass on the temporal quadrant with superior and inferior extensions was observed in 1 patient. Moderate to high internal reflectivity was observed on ultrasonographic biomicroscopy in all 3 individuals. Biopsies of the ciliary body masses were diagnosed as sarcoidosis in all 3 patients.

Conclusions and Relevance  These findings support that diffuse or segmental ciliary body mass may serve as a clinical sign and tissue source for biopsy in the diagnosis of ocular sarcoidosis, although the frequency of this cannot be determined from 3 cases. To our knowledge, such cases all demonstrate a uveitic component; whether a ciliary body mass caused by sarcoidosis can occur in the absence of uveitis remains unknown.

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