OCULAR MANIFESTATIONS OF SYSTEMIC GRANULOMATOUS DISEASES

Many systemic granulomatous diseases may affect the eye. This review emphasizes those diseases that have been found more frequently in recent years and that have become a major problem to ophthalmologists because of the difficulties in early diagnosis and adequate treatment. Today, we face a resurgence of ocular syphilis, especially the acquired from associated with neurologic involvement and human immunodeficiency virus infection. More severe, atypical forms of the disease have recently appeared. Ocular toxoplasmosis represents a clinical challenge, especially in the immunocompromised patient, in whom the severity of the chorioretinitis, the frequency of complications, and the treatment difficulty become major problems. Ocular sarcoidosis frequently is the initial presentation of the systemic disease, and its early detection and treatment may prevent late, severe complications. In the case of Lyme disease, the incidence and both the number and variety of ocular manifestations have increased in recent years, and Wegener's granulomatosis represents a major diagnostic problem. The detection of antineutrophil cytoplasmic antibodies facilitates the early diagnosis and prevents disastrous complications of the disease. Finally, ocular leprosy, a major cause of blindness, especially in Africa, Asia, and South America, and ocular tuberculosis are important mycobacterial infections that affect the eye with fatal consequences if not detected and treated early in their course.