A patient with past medical history, recently diagnosed Sjogren’s syndrome, connective tissue disease, psoriasis, eczema, and past ocular history of dry eyes, epiretinal membrane, ocular hypertension, cataracts presented with bilateral itchiness and foreign body sensation. She had constant itching and redness. Her visual acuity was 20/20 in both eyes and her intraocular pressure was 17 and 27. Her slit lamp exam was notable for bilateral palpebral and bulbar follicular conjunctivitis and superficial punctate keratopathy in both eyes. Fundus exam was unremarkable in both eyes. Her brimonidine and dorzolamide-timolol eye drops were switched to preservative-free timolol. Bilateral conjunctival cultures were taken, which showed no growth of bacteria, fungus or virus. Bilateral conjunctival biopsy were taken and showed non-caseating granulomatous inflammation with surrounding lymphocytic infiltrate. No organisms identified on Gram, Grocott's methenamine silver, or Acid-fast bacteria staining. The biopsy results were consistent with sarcoidosis. Patient was started on 0.5% cyclosporine and preservative-free artificial tears. She was referred to rheumatologist for further systemic work-up.
Presentation Date: 09/15/2022
Issue Date: 10/14/2022