Sarcoid conjunctival granuloma responding to biological therapy

IntroductionConjunctival involvement in sarcoidosis typically presents as non-scarring granulomatous inflammation; however, cicatricial conjunctivitis represents a rare and poorly characterised manifestation. There are currently no published reports of sarcoid-related conjunctival granulomas with cicatrising features responding to anti-TNF therapy. We present the first case of biopsy-confirmed conjunctival sarcoidosis with progressive scarring successfully treated with adalimumab after failure of conventional immunosuppression.Case DescriptionA 47-year-old male with biopsy-proven systemic sarcoidosis presented with recurrent anterior uveitis and progressive conjunctival granulomas, unresponsive to corticosteroids and mycophenolate. He developed forniceal foreshortening, symblepharon formation, and a dense cataract. Conjunctival biopsy confirmed non-necrotizing granulomatous inflammation. Adalimumab was initiated following disease progression on conventional therapy. Within six months, ocular surface inflammation resolved, enabling successful cataract surgery and visual rehabilitation.ConclusionTo our knowledge, this is the first documented case of sarcoid-related cicatricial conjunctivitis with histological confirmation responding favourably to anti-TNF therapy. This report suggests adalimumab may be a valuable option in cases of treatment-resistant ocular surface sarcoidosis and may guide future therapeutic decision-making.