HEMORRHAGIC RETINOPATHY AS THE PRESENTING MANIFESTATION OF SARCOIDOSIS

Background: The diagnosis of ocular sarcoidosis is particularly challe nging in patients who present with atypical clinical findings and no e vidence of systemic disease. We describe a patient whose initial clini cal manifestation of sarcoidosis was a unilateral hemorrhagic retinopa thy. Method: Clinicopathologic case study. Results: The diagnosis of s arcoidosis in this patient was delayed for over a year principally bec ause of the atypical retinal findings and because repeated chest X-ray s and serum angiotensin converting enzyme (ACE) levels were normal. Su rgical enucleation of the eye once it was blind revealed a large nonca seating granuloma of the ciliary body. Inflammation and thrombosis of several large caliber retinal veins and a single branch of the retrola minar hemicentral retinal vein were found. Conclusions: Major retinal branch vein occlusion and hemi-central retinal branch occlusion are ra re complications of ocular sarcoidosis. Normal serum ACE levels do not exclude the diagnosis of ocular sarcoidosis even in patients with con siderable amounts of intraocular granulomatous inflammation.