UVEITIS AS A PRESENTING FEATURE OF CHRONIC SARCOIDOSIS

Uveitis is often a manifestation of sarcoidosis. Less well-recognized, however, is the development of uveitis several years before the diagn osis of systemic sarcoidosis. The possibility that presentation of uve itis is a marker for the chronicity of sarcoidosis has never been inve stigated. The aim of this work was to evaluate, in a Caucasian populat ion, the epidemiology of uveitis as the primary manifestation of sarco idosis with long-term follow-up, and the relationship of uveitis to th e chronicity of sarcoidosis. The records of 1,156 Caucasian patients w ith histologically proven sarcoidosis, first seen in the period 1976-1 992, were reviewed. In patients in whom uveitis was the primary featur e of sarcoidosis, the following parameters were identified: systemic m anifestations; time interval between the diagnosis of uveitis and sarc oidosis; therapy; the evolution of chest radiographic image over time; chronicity; the relationship between sarcoidosis and uveitis; and, fi nally, status in October 1994. In nine patients, uveitis was the reaso n for seeking medical treatment, resulting in the discovery of systemi c sarcoidosis, which was then found to be chronic in 7 out of 9 cases. In an additional eight patients, uveitis preceded the diagnosis of sy stemic sarcoidosis by 1-11 yrs, and yet most subjects had systemic man ifestations that went unrecognized during this time period, with chest radiograph at the time of diagnosis suggesting a long-standing chroni c disease. Thus, uveitis appeared to be the primary manifestation of s arcoidosis in 17 of the 1,156 patients studied (1.5%). In conclusion, any uveitis of unknown origin may be due to sarcoidosis, although its systemic manifestations may not occur for up to 11 yrs. Uveitis patien ts need a very long-term follow-up, including periodic diagnostic test s for systemic sarcoidosis, Furthermore, when uveitis precedes the sys temic symptoms and diagnosis of sarcoidosis by more than one year, it may be regarded as a marker of the chronicity of sarcoidosis.