Optic nerve head granuloma as a primary manifestation of ocular sarcoidosis - A tertiary uveitis clinic experience

PURPOSE: To report a case series of ocular sarcoidosis manifesting as optic nerve head granuloma. DESIGN: Observational case series. RESULTS: Unilateral presentation in three females and a male. None of them had symptoms suggestive of systemic involvement. Fundus examination in all the patients showed hyperemic optic discs with peripapillary subretinal granuloma. Serum angiotensin converting enzyme was elevated in all patients. Chest radiograph was within normal limits in all patients. High resolution computed tomography of the chest showed features of sarcoidosis in two patients. All patients were treated with oral steroids. Immunosupressants were given in three patients, intravenous steroid, followed by oral steroids given in three patients. Improvement in visual acuity was noted in all four patients. CONCLUSION: Primary optic nerve involvement in sarcoidosis is rare. Isolated optic nerve sarcoidosis may exist without any systemic manifestations. Corticosteroids with immunosuppressants form the mainstay of therapy.