Ocular sarcoidosis in patients without symptoms rare in Finland
Eye involvement found with exams in 2% of 262 sarcoidosis patients at a center
In Finland, only 2% of sarcoidosis patients without symptoms of eye involvement indeed had ocular sarcoidosis, suggesting that routine eye examinations are not needed in the Finnish patient population.
But as the frequency of ocular sarcoidosis varies considerably among people with sarcoidosis worldwide, “more studies are needed to determine the utility of baseline [initial] eye exams in sarcoidosis in different populations,” the researchers wrote.
Factors specific to people living in a given region, like genetics, may be involved, they added.
Their study “Low utility of ocular screening in sarcoidosis in Finland,” was published in the journal Acta Ophthalmologica.
Incidence of ocular sarcoidosis varies among patient groups
Sarcoidosis develops when clusters of inflammatory cells, called granulomas, form in one or more organs, leading to damage. While the lungs are most commonly affected, other organs frequently affected include the lymph nodes, skin, and eyes.
“The prevalence of ocular [eye] involvement in sarcoidosis varies from 5% to 80% in different study populations,” the researchers wrote, being more common in Japan, in African American people, and among women.
Uveitis, or inflammation of an eye layer called uvea, is one of the most common complications of ocular sarcoidosis. Previous studies have suggested that most patients with ocular sarcoidosis have eye symptoms and need treatment.
While “eye exams are recommended for patients with sarcoidosis because undiagnosed and untreated ocular sarcoidosis can result in loss of vision,” there is limited “evidence on the benefit of ocular screening of asymptomatic patients,” the researchers wrote.
Researchers at Tampere University Hospital evaluated the usefulness of eye screenings among 262 sarcoidosis patients who had no history of ocular sarcoidosis and no symptoms suggesting eye involvement.
All had undergone eye examinations at that hospital’s Tays Eye Center between 2014 to 2021, either a screening that focused on ocular sarcoidosis or a comprehensive eye exam for other conditions.
Retrospectively reviewing patients’ clinical data, the researchers found five of these asymptomatic patients (2%) had ocular sarcoidosis — specifically uveitis.
Five of 262 screened patients treated for uveitis after examination
Notably, “all findings of ocular sarcoidosis were among patients who were screened specifically for ocular sarcoidosis (5 of 172, 3%),” while no eye involvement “was detected with untargeted eye exams,” the scientists wrote.
“None of the patients with a history of an eye disease were diagnosed with ocular sarcoidosis,” they added.
All five patients started treatment for uveitis on the examination day, and none developed vision loss. One patient had a uveitis-related complication.
Two patients had unilateral (affecting only one eye) nongranulomatous anterior uveitis, meaning that the inflammation affected the inside of the front part of eye and showed no granulomas. They were treated with topical [eye-administered] steroids for three to four weeks, with no further inflammation at their last visit.
One patient had nongranulomatous anterior uveitis that affected both eyes. Topical steroid treatment was given for eight weeks, with a full recovery after week four. The patient had an asymptomatic uveitis relapse nine years later that also fully resolved with topical steroids.
Another patient showed a unilateral granuloma mass in a vascularized part of the eye that perturbed the optical nerve, which relays signals between the eyes and the brain. The granuloma resolved with treatment that included whole-body steroids for one year, followed by the immunosuppressant azathioprine.
The last case showed lesions in both eyes that suggested chorioretinitis, a type of uveitis involving the posterior segment of the eye. No active inflammation was detected, but four months after the eye exam the patient developed symptoms of extensive uveitis. Treatment, which was still underway at the study’s publication, included topical and whole-body steroids.
“In retrospect, only two patients (1%) required treatment based on the findings at the screening,” the researchers wrote. The two patients with “unilateral, low-grade anterior uveitis could also have been monitored without treatment,” and the patient with lesions “did not require treatment” until symptom onset.
The “rate of asymptomatic sarcoidosis-related ocular involvement was low, 2%, in this Finnish population,” which “is lower than in any previous study,” the researchers wrote.
“Population-dependent factors, such as genetics, may contribute to the difference in the prevalence of ocular sarcoidosis seen in sarcoidosis studies,” they added.
Overall, these findings suggest that due to the low rate of eye involvement “screening for ocular sarcoidosis is not useful in the Finnish population,” the researchers wrote. As a result, “we discontinued providing systematic ocular screening of sarcoidosis at Tays Eye Centre.”
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