Abstract Listings 2024

Purpose

To monitor and assess the management of biopsy-proven orbital sarcoidosis.

Methods

Retrospective case series of patients with biopsy-proven orbital sarcoidosis attending the oculoplastics department at King’s College Hospital, London between 2019-2023.

Results

We identified 7 cases of orbital sarcoidosis. Mean age was 66 years (47-89), with a female:male ratio of 5:2. Patient ethnicities were Caucasian (3), Black African/Caribbean (2), and Asian (2). Presenting symptoms were eyelid swelling (3), ptosis (2), proptosis (1), and lacrimal gland swelling (1). Only 2 patients had a previously established diagnosis of sarcoidosis. All patients received blood tests: ACE (mean 62, range 8-52 IU/L), Ca2+ (2.56, 2.1-2.6mmol/L), and ESR (19, 0-20mm/hr), whole body PET-CT, MRI and a biopsy. The most common location of the orbital lesion on MRI scan was the orbit (3), followed by eyelids (2) and lacrimal glands (2). PET-CT showed manifestations of systemic sarcoidosis in 3 patients. All patients received intra-operative and a 2 week course of post-biopsy glucocorticoids. 1 patient underwent further excision of the orbital lesion, but all patients elected for monitoring rather than prolonged immunosuppression. All reported good outcomes and none demonstrated progression of disease at the final follow up.

Conclusion

Orbital sarcoidosis can present a diagnostic and management quandary. The presentation can easily masquerade as other conditions and prompt imaging and histopathology is required if it is suspected. In the absence of a systemic flare, patients with orbital sarcoidosis can safely have expectant management without undergoing prolonged systemic immunosuppression in the first instance. Longer term data is necessary to assess the natural history of the condition.

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