A 36-year-old man had noticed a dark spot in the field of vision of his left eye. Now the spot more closely resembled a line. He denied other changes in his vision and had not seen floaters or flashing lights. Earlier, he had ankle and wrist swelling. The diagnosis was acute reactive arthritis, with sarcoidosis as the possible underlying cause.
Examination of the optic discs revealed bilateral papilledema. A chest CT scan showed mediastinal and hilar lymphadenopathy. A transbronchial biopsy showed non-necrotizing granulomas, confirming a diagnosis of neurosarcoidosis.
Optic nerve dysfunction is the most common neuro-ophthalmological manifestation of sarcoidosis. The optic nerve is said to be the second most frequently affected cranial nerve, after the facial nerve. The optic nerve may be affected at any time during the course of the disease and may be the site of its initial presentation.
Papilledema, as seen in this patient, may result from elevated intracranial pressure, which often is associated with neurosarcoidosis.
Case and image courtesy of Leonid Skorin, Jr, DO