gms | German Medical Science

102. Jahrestagung der DOG

Deutsche Ophthalmologische Gesellschaft e. V.

23. bis 26.09.2004, Berlin

Neuro-ophthalmologic initial presentation of sarcoidosis

Meeting Abstract

  • corresponding author C. Lamirel - Ophthalmology, Fondation Rothschild Paris; CHU Angers
  • C. Vignal-Clermont - Ophthalmology, Fondation Rothschild Paris
  • K. Berthet - Neurology, Hopital Lariboisière Paris
  • M.G. Bousser - Neurology, Hopital Lariboisière Paris
  • O. Gout - Neurology Fondation Rothschild Paris/F

Evidenzbasierte Medizin - Anspruch und Wirklichkeit. 102. Jahrestagung der Deutschen Ophthalmologischen Gesellschaft. Berlin, 23.-26.09.2004. Düsseldorf, Köln: German Medical Science; 2004. Doc04dogSA.10.08

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Veröffentlicht: 22. September 2004

© 2004 Lamirel et al.
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To describe different forms of neuro-ophthalmologic onset in sarcoidosis: clinical signs, meaning of diagnosis, treatment and evolution.


13 patients with neuro-ophthalmologic initial onset of sarcoidosis have consulted three neuro-ophthalmologic consultations between 1997 and 2003. There were 10 women and 3 men, with a mean age of 32 years. 6 patients suffered from diplopia, 9 patients had involvement of the anterior visual pathway, with 2 patients who had both. In 3 cases, the cavernous sinus was involved with 2 cases with V and VI cranial nerves pareses, and 1 case with III, V and VI cranial nerves pareses. The three other patients with diplopia had meningo-radiculitis. Concerning the visual pathway, the infiltration concerned the optic nerve in 2 cases, the chiasmal in 2 cases and 3 patients had papilloedema secondary to intracranial hypertension. The dosage of the angiotensin-converting enzyme was performed in 9 patients and elevated in only 4 cases. 9 patients underwent lumbar punctures, 5 had a cerebrospinal fluid protein elevated with 3 cases of lymphocytic pleiocytosis. 7 patients had mediastinal adenopathies on chest CT scan among the 11 performed.

11 patients had a histological proof of sarcoidosis. The two other patients had enough clinical evidence to support this diagnosis (one had a negative biopsy). All of them were treated with systemic corticosteroids. The diplopia was improved for the 6 patients without relapse. Concerning the 6 patients with optic nerve or chiasmal infiltration, one wasn't improved, 2 had a partial improvement, and 3 had a completed recovery. 2 of these patients relapsed.


Diplopia and anterior visual pathway abnormalities can be initial onset of sarcoidosis and this diagnosis must stay in mind in front of these usual signs in a neuro-ophthalmologic consultation. Complementary exams are needed to confirm this diagnosis at best with a histological proof. The treatment is corticosteroid with generally a great improvement even if relapse can occur.