A patient presented with three months of left eye swelling and pain. He was found to have periorbital firmness and fullness, proptosis, and conjunctival chemosis. He underwent computed tomography imaging of the orbits with contrast, which demonstrated an ill-defined, irregular and enhancing mass centered in the inferior and lateral quadrant of the left orbit. There was encasement of the inferior and lateral extraocular muscles, secondary proptosis, and displacement of the left lacrimal gland. He underwent biopsy of the lesion, with histopathology showing non-caseating granuloma without evidence of bacterial, fungal, or mycobacterial infection. He underwent a chest x-ray that demonstrated bilateral hila fullness. He was subsequently diagnosed with likely orbital sarcoidosis with concern for pulmonary sarcoidosis on imaging. Sarcoidosis is a multi-system granulomatous inflammatory disease of unknown etiology. Life threatening manifestations include cardiac and pulmonary disorders. Ocular involvement is diverse and can include eyelid and adnexal involvement, conjunctival involvement, uveitis, and orbital involvement. Orbital sarcoidosis presents in diverse ways and can be the presenting manifestation of the disease. Treatment options for orbital sarcoidosis include observation, surgical debulking, corticosteroids, and systemic immunomodulatory therapy. Referral to cardiology, rheumatology, and pulmonology is essential.
Presentation Date: 07/28/2022
Issue Date: 08/05/2022
Continuing Medical Education (CME)