This is the CT scan of a patient with sore eyes. He is otherwise fit and well.

a. What does the scan show?

b. What laboratory tests may be positive?

c. List the ocular signs which may be 
    present?

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Answers:
This is the CT scan of a patient with sore eyes. He is otherwise fit and well.
 

a. What does the scan show?

Bilateral hilar lymphadenopathy.
This is typically seen in patient with sarcoidosis.
b. What laboratory tests may be positive?
  • serum angiotensin-converting enzyme (ACE)  is raised in 75% of patients
  • serum calcium is raised in active sarcoidosis
  • transbronchial biopsy shows the presence of granuloma in 90% of patients 

    • with pulmonary involvement.
  • Kveim's test. In this test, sarcoid tissue is injected intradermally and the skin 

    • is then excised 6 weeks later and examined microscopically for non-caseating 
    granuloma. The test carries the risk of transmitting disease and is rarely used.


c. List the ocular signs which may be present?

    Anterior segment:
      • lupus pernio of the eyelids
      • episcleritis
      • scleritis
      • band keratopathy
      • anterior uveitis


    Posterior segment