Sarcoidosis masquerading non-arteritic ischemic optic neuropathy

Sarcoidosis, a multisystem granulomatous disease, can occasionally involve the optic nerve, often presenting as optic neuritis. However, its association with Non-Arteritic Anterior Ischemic Optic Neuropathy (NAAION) is rare and can create diagnostic challenges. Here, we report a case of a 52-year-old male who initially presented with sudden visual loss in his left eye, diagnosed clinically as NAAION with a disc at risk in the right eye (RE). He was managed with antiplatelets and steroids. Three months later, he experienced vision loss in the RE with evidence of bilateral intraocular inflammation. Imaging, including Fundus Fluorescein Angiography and Indocyanine Green Angiography, revealed choroidal granulomas, raising differential diagnoses of Sarcoidosis, Vogt-KoyanagiHarada disease, and Tuberculosis. Intravenous methylprednisolone followed by oral steroids resulted in visual improvement in both eyes. This case underscores the importance of comprehensive assessment and imaging to identify atypical presentations of sarcoidosis masquerading as NAAION, ensuring timely intervention and improving visual outcomes.