J Korean Ophthalmol Soc.  2014 Oct;55(10):1549-1553. 10.3341/jkos.2014.55.10.1549.

A Case of Isolated Orbital Sarcoidosis

• Park JS
• Kwak MS

• KMID: 2216877
• DOI: http://doi.org/10.3341/jkos.2014.55.10.1549

Abstract

PURPOSE
The authors report a case of orbital sarcoidosis without evidence of systemic involvement.
CASE SUMMARY
A 33-year-old female had a 1 month history of erythematous eyelid swelling. On physical examination, a firm and non-tender mass was observed diffusely along the upper, lower and medial canthal areas. A computed tomography (CT) scan showed a diffuse mass in the anterior orbit. We performed an incisional biopsy and histopathological examination revealed non-caseating granulomas and no evidence of a foreign body. Acid-fast-bacilli (AFB), methenamine silver and periodic-acid-schiff (PAS) stain showed no evidence of infection and chest radiograph was normal. Polymerase chain reaction (PCR) and interferon gamma secretion test showed no evidence of tuberculosis. Antinuclear antibody (ANA) and antineutrophil cytoplasmic antibody (ANCA) were negative and angiotensin converting enzyme (ACE) was within the normal range. Further systemic evaluations were compatible with a diagnosis of orbital sarcoidosis and oral prednisone was prescribed. Six weeks later, the erythematous eyelid swelling had disappeared and there was no evidence of recurrence to date.

Keyword

Non-caseating granuloma; Ocular sarcoidosis; Orbital sarcoidosis

MeSH Terms

Adult
Antibodies, Antineutrophil Cytoplasmic
Antibodies, Antinuclear
Biopsy
Diagnosis
Eyelids
Female
Foreign Bodies
Granuloma
Humans
Interferons
Methenamine
Orbit*
Peptidyl-Dipeptidase A
Physical Examination
Polymerase Chain Reaction
Prednisone
Radiography, Thoracic
Recurrence
Reference Values
Sarcoidosis*
Tuberculosis
Antibodies, Antineutrophil Cytoplasmic
Antibodies, Antinuclear
Interferons
Methenamine
Peptidyl-Dipeptidase A
Prednisone

Figure

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  Figure 1. The initial digital photograph shows an erythematous eyelid swelling along the upper, lower and medial canthal area.

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  Figure 2. The initial computed tomographic scans, (A) axial and (B) coronal, show a diffuse orbital mass in the inferomedial portion (yellow arrows).

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  Figure 3. (A) A photomicrograph of the biopsy shows multifocal granulomas (hematoxylin and eosin stain, ×40). (B) High magnification view shows a well formed, non-caseating granuloma composed predominantly of epithelioid histiocytes (hematoxylin and eosin stain, ×200).

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  Figure 4. The initial chest radiograph shows no evidence of a hilar or parenchymal lesion.

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  Figure 5. Seven months after treatment, the digital photograph shows no evidence of the erythematous eyelid swelling.

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  Figure 6. Seven months after treatment, the computed tomographic scans, (A) axial and (B) coronal, show no evidence of the orbital mass.

Reference

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