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Ocular sarcoidosis in Kuwait with a review of literature

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Abstract

Objective: To study 18 cases of sarcoidosis, the hall mark of which was uveitis. Setting: Referrals from peripheral eye clinics. Patients: 18 patients with bilateral almost symmetric uveitis, negative Mantoux test and positive gallium scan were enrolled in the study. Preliminary bronchoscopy and bronchial lavage were not done due to social habits. Results: Age ranged between 7–48 years with median 15 and mean 19 years. Although the patients were multinational, yet all of them were residents of Kuwait. A father and son were affected within 8 months period. 78% were strictly ocular, associated pulmonary and salivary gland affection 11% each. Sole anterior uveitis was found in 28%,associated with intermediate uveitis in 55% and with posterior in16.6% of cases. Clinically detectable dry eyes associated 33% of cases. All our patients developed glaucoma which resolved with treatment of uveitis in 88% of them. Gallium uptake of the eye balls was found in 22%, of the lacrimal glands (panda sign) in 67%, and of the salivary glands or chest 11% each. Positive biopsy was found in 72%, 22% of which was conjunctival. Chest X-ray and SACE were positive in 11%.61% had hypergammaglobulinaemia and all had negative ANA and RF. Conclusions: (1) 61% of ocular sarcoidosis presented below sarcoid age. (2) Multinationality together with father‘s and son‘s affection indicate aclimatic or environmental insult in an already predisposed person. (3) Routine chest X-ray and SACE may not be adequate for diagnosis of ocular sarcoidosis. Gallium should be done in suspected cases. (4)Follow-up for prospects is emphasized.

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References

  1. Hamze M, Sohier R, Betvel H, Ben Ayed H. HLA-B5 and Behcet’s disease. International Symposium on Behcet’s disease. 1977: Abstr 54, September 29–30. Sermet Metabassi, Istanbul.

    Google Scholar 

  2. Palimeris G, Theodissiadis G, Koliopoulos J, Roussos J. Adamantiodes-Behcet’s syndrome in Greece. Trans Ophthalmol Soc UK 1980; 100: 527–32.

    PubMed  CAS  Google Scholar 

  3. Ninth Congress of International Society of Geographical Ophthalmol and Third Mediterranean Symposium of Rheumatology. Behcet’s disease, combined session 1986, May 2, Hotel Mechiel Tunis (a) Benamour S, Zaoui A, Bennis R, Benmimoun M et al., Maladie de Behcet. A propos de 150 cas Abstr 8 and (b) Al-Rawi ZS, Sharquie KE, Khalifa SI, Al-Hadithi FM, Munir JJ, Behcet’s disease in Iraqi patients. Abstr II.

  4. Mousa A, Marafie A, Al-Rifai K, Dajani A, Mukhtar M. Behcet’s disease in Kuwait Arabia. A report of 29 cases and a review. Scand J Rheumatology 1986; 15: 310–532.

    CAS  Google Scholar 

  5. Noor Sunba MS, Al-Awqati M, Sheriff S. The diagnostic significance of patients with uveitis. Acta Ophthalmol (Cophen) 1988; 66: 709–11.

    Article  CAS  Google Scholar 

  6. O’Duffy ID, Kokmen E. ‘Editor’ Behcet’s disease basic and clinical aspects. Chapter 38: pp. 259–267, 1989. Publisher Marcel Dekker Inc NY. (a) Benamour R, Bennis R, Amraowi A. A study of 285 cases of Behcet’s disease chapter 38: pp 259–267 (b) Helmy S, Khalil A. Clinical, genetic, immunological biomedical features of 180 Egyptian patients with Behcet’s disease. 39: 269–276.

    Google Scholar 

  7. Diab S, Karnik A, Ouda B, Denath F, et al. Sarcoidosis in Arabs: The clinical profile of 20 patients and a review of the literature. Sarcoidosis 1991; 8: 56–52.

    PubMed  CAS  Google Scholar 

  8. Khan J, Dossing M, van Sinner WN, Bazabashi M, Curley W. Sarcoidosis in native Saudis. Sarcoidosis 1993; 10: 50–55.

    PubMed  CAS  Google Scholar 

  9. Karma A. Diagnostic aspect of ocular sarcoidosis. 1994; 11: 58–60.

    CAS  Google Scholar 

  10. Daniele RP, Rowlands DT. Antibodies to T-cells in sarcoidosis. Ann NY Acad Sci 1976; 278: 88–92.

    PubMed  CAS  Google Scholar 

  11. Daniele RP, Dauber JH, Rossman MD. Immunologic abnormalities in sarcoidosis. Ann Int Med 1980; 92: 416–418.

    Google Scholar 

  12. Lopez-Majano V, Mathuswamy, Renzi G. Gallium 67 scintigraphy in the localisation of sarcoidosis. In: Grassic Rizzato G, Pozzi (eds) ‘Sarcoidosis and other granulomatous disorders’. Elsevier Science Publishers, Amsterdam, pp 519–520, 1988.

    Google Scholar 

  13. Nidiry JJ, Mines S, Hackney R, Nabhani H. Sarcoidosis: A unique presentation of dysphagia, myopathy and photophobia. Am J Gastroenterol 1991; 86: 1679; 1682.

    PubMed  CAS  Google Scholar 

  14. Israel HL, Albertine KH, Park CH, Patrick H. Whole-body gallium 67 scans. Role in diagnosis of sarcoidosis. Am Rev Respir Dis 1991; 144: 182–6.

    Google Scholar 

  15. Stadnyk BN, Ruinstein I, Grossman RF, et al. Clinical features of sarcoidosis in elderly patients. Sarcoidosis 1988; 5: 121–3.

    PubMed  CAS  Google Scholar 

  16. Hetherington S. Sarcoidosis in young children. Am J Dis Child 1982; 136: 13–5.

    PubMed  CAS  Google Scholar 

  17. Pattishall EN, Strope GL, Spinola SM, Denny FD. Childhood sarcoidosis. J Pediatr 1986; 108: 169–77.

    Article  PubMed  CAS  Google Scholar 

  18. Cohen KL, Peiffer RL, Powell DA. Sarcoidosis and ocular disease in a young child. Arch Ophthalmol 1981; 99: 422–4.

    PubMed  CAS  Google Scholar 

  19. James DG, Neville E, Siltzbach E. A worldwide review of sarcoidosis. Ann NY Acad Sci 1976; 278: 321–34.

    PubMed  CAS  Google Scholar 

  20. Communiskey J. Sarcoidosis among the Irish. Lancet 1976; 1: 366–7.

    Article  Google Scholar 

  21. Teirstein AS, Siltzbach LE, Berger H. Patterns of sarcoidosis in three population groups in New York City. Ann NY Acad Sci 1976; 278: 271–6.

    Google Scholar 

  22. Giotaki HA. Present status of sarcoidosis in West Greece. Sarcoidosis 1988; 5: 147–9.

    PubMed  CAS  Google Scholar 

  23. Silver MR, Messner LV. Sarcoidosis and its ocular manifestations. J Am Optom Assoc 1994; 65(5): 321–7.

    PubMed  CAS  Google Scholar 

  24. Stewart IC, Davidson N. Clustering of sarcoidosis. Thorax 1982; 37: 298–399.

    Google Scholar 

  25. Brennan NJ, Crean P, Long JP et al. High prevalence of familial sarcoidosis in an Irish population. Thorax 1984; 39: 14–8.

    PubMed  CAS  Google Scholar 

  26. Kremer JM. Histologic findings in siblings with acute sarcoid arthritis association with the B8, DR3 phenotype. J Rheumatol 1986; 13: 593–7.

    PubMed  CAS  Google Scholar 

  27. Parks SA, Baker SB, Bourdillon RE, Murray CR, Rakshit M. Epidemiology of sarcoidosis in the Isle of man. A case controlled study. Thorax 1987; 42: 420–6.

    Article  Google Scholar 

  28. Hills SE, Parkes SA, Baker SB. Epidemiology of sarcoidosis in the Isle of man. 2. Evidence of spacetime clustering. Thorax 1987; 427–30.

  29. Obenauf CD, Shaw HE, Sydnor CF, Klintworth GK. Sarcoidosis and its ophthalmic manifestations. Am J Ophthalmol 1978; 86: 648–55.

    PubMed  CAS  Google Scholar 

  30. Jabs DA, Johns CJ. Ocular involvement in chronic sarcoidosis. Am J Ophthalmol 1986; 102: 297–301.

    PubMed  CAS  Google Scholar 

  31. Nussenblatt RB, Whitcup SM, Palestine AG. Sarcoidosis. In: ‘Uveitis fundamental and clinical practice’, Second ed. Mosby–Year Book, St. Louis, 21: pp. 289–298, 1996.

    Google Scholar 

  32. Spalton DJ, Sanders MD. Fundus changes in histologically confirmed sarcoidosis. Br J Ophthalmol 1987; 65: 348–58.

    Google Scholar 

  33. Vrabec TR, Augsburger JJ, Fischer DW, Jonathan BB, Tashayyad D, Israel HL. Taches de bougie. Ophthalmology 1995; 102: 1712–21.

    PubMed  CAS  Google Scholar 

  34. Hart WM Jr, Burde RM. Optic disc edema in sarcoidosis. Am J Ophthalmol 1979; 88: 769–71.

    PubMed  Google Scholar 

  35. Sanders MD, Shilling JS. Retinal, chorio-retinal and optic disc involvement in sarcoidosis. Trans Ophthalmol Soc UK 1976; 96: 140–4.

    PubMed  CAS  Google Scholar 

  36. Brinkman CJJ, Rothova A. Fundus pathology in neurosarcoides. Int Ophthalmol 1993; 17: 23–6.

    Article  PubMed  CAS  Google Scholar 

  37. Statton R, Biodi FC, Hanigan J. Sarcoidosis of the optic nerve. Arch Ophthalmol 1964; 71: 834–6.

    PubMed  CAS  Google Scholar 

  38. Gudeman SK, Selhorst JB, Susac JO, Waybright EA. Sarcoid optic neuropathy. Neurology 1982; 32: 597–603.

    PubMed  CAS  Google Scholar 

  39. Stern BJ, Krumhole A, Johns C, Scott P, Nession J. Sarcoidosis and its neurological manifestations. Arch Neurol 1985; 42: 909–17.

    PubMed  CAS  Google Scholar 

  40. Grohagen-Riska C. Angiotensin-converting enzyme I. Activity and correlation with serum lysozyme in sarcoidosis, other chest or lymph nodes diseases on healthy persons. Scan J Respir Dis 1979; 6: 83–93.

    Google Scholar 

  41. Weinreb RN, Barth R, Kimura SJ. Limited gallium scans and angiotensin converting enzyme in granulomatous uveitis. Ophthalmology 1980; 87: 202–9.

    PubMed  CAS  Google Scholar 

  42. Quigley C, Blake MA, Ward K, Blake J, Fitzgerald MX. Eye disease in 260 consecutive patients attending an Irish sarcoid clinic. Sarcoidosis Suppl 1982; 9: 363–4.

    Google Scholar 

  43. Karma A, Huhti E, Poukkula A. Course and outcome of ocular sarcoidosis. Am J Ophthalmol 1988; 106: 467–72.

    PubMed  CAS  Google Scholar 

  44. Siltzbach LE. Sarcoidosis: Clinical features and management. Med Clin North Am 1967; 51: 483–502.

    PubMed  CAS  Google Scholar 

  45. Hersbey JM, Pulido JS, Folbert R et al. Non caseating conjunctival granulomas in patients with multifocal choroiditisand panuveitis. Ophthalmol 1994; 101: 596–601.

    Google Scholar 

  46. Karcioglu ZA, Brear R. Conjunctival biopsy as an aid in the evaluation of the patient with sarcoidosis. Ophthalmology 1980; 87: 287–91.

    Google Scholar 

  47. Palestine AG, Nussenblatt RB, Chan CC. Treatment of intraocular complications of sarcoidosis. Ann NY Acad Med 1986; 465: 564–73.

    CAS  Google Scholar 

  48. Wienreb RN, Tessier H. Laboratory diagnosis of ophthalmic sarcoidosis. Surv Ophthalmol 1984; 28: 653–64.

    Article  Google Scholar 

  49. Study PR, Lapworth R, Bird R. Angiotensin-converting enzyme and its statistical significance: A review. J Clin Pathol 1983; 938–47.

  50. Link SD, Kremer JM. Cutaneous and musculoskeletal features, diagnostic modalities and immunopathology in sarcoidosis. Curr Opin Rheumatol 1994; 6: 78–81.

    Article  Google Scholar 

  51. Hunninghake GW, Crystal RG. Mechanism of hypergammaglobulinaemia in pulmonary sarcoidosis. Site of increased antibody production and role of T-lymphocytes. J Clin Invest 1981; 67: 86–92.

    Article  PubMed  CAS  Google Scholar 

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Hegab, S.M., Al-Mutawa, S.A. & Sheriff, S.M. Ocular sarcoidosis in Kuwait with a review of literature. Int Ophthalmol 21, 255–260 (1997). https://doi.org/10.1023/A:1006082605091

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