Ocular sarcoidosis in Kuwait with a review of literature

Objective: To study 18 cases of sarcoidosis, the hall mark of which was uveitis. Setting: Referrals from peripheral eye clinics. Patients: 18 patients with bilateral almost symmetric uveitis, negative Mantoux test and positive gallium scan were enrolled in the study. Preliminary bronchoscopy and bronchial lavage were not done due to social habits. Results: Age ranged between 7–48 years with median 15 and mean 19 years. Although the patients were multinational, yet all of them were residents of Kuwait. A father and son were affected within 8 months period. 78% were strictly ocular, associated pulmonary and salivary gland affection 11% each. Sole anterior uveitis was found in 28%,associated with intermediate uveitis in 55% and with posterior in16.6% of cases. Clinically detectable dry eyes associated 33% of cases. All our patients developed glaucoma which resolved with treatment of uveitis in 88% of them. Gallium uptake of the eye balls was found in 22%, of the lacrimal glands (panda sign) in 67%, and of the salivary glands or chest 11% each. Positive biopsy was found in 72%, 22% of which was conjunctival. Chest X-ray and SACE were positive in 11%.61% had hypergammaglobulinaemia and all had negative ANA and RF. Conclusions: (1) 61% of ocular sarcoidosis presented below sarcoid age. (2) Multinationality together with father‘s and son‘s affection indicate aclimatic or environmental insult in an already predisposed person. (3) Routine chest X-ray and SACE may not be adequate for diagnosis of ocular sarcoidosis. Gallium should be done in suspected cases. (4)Follow-up for prospects is emphasized.