Ocular sarcoidosis: from clinical signs to targeted interventions

Ocular sarcoidosis is a frequent manifestation of sarcoidosis and may occur most commonly affecting adults between 30 and 60 years old. Uveitis may be anterior, intermediate, posterior, or present as panuveitis, with marked heterogeneity in severity and clinical course. Diagnosis relies on a combination of compatible ocular findings and systemic investigations, including serum biomarkers, thoracic imaging, and histological evidence of noncaseating granulomas while carefully excluding infectious and neoplastic mimickers, particularly in atypical or corticosteroid-resistant cases. Bilateral, intermediate, posterior, and panuveitis often require systemic corticosteroids. Because of the unfavorable long-term safety profile of systemic corticosteroids, early introduction of steroid-sparing therapy is recommended in chronic, severe, or recurrent disease. Emerging therapies such as interleukin-6 receptor antagonists, Janus kinase inhibitors, and mTOR inhibitors represent promising options on top of methotrexate and TNF inhibitors for refractory sarcoid uveitis, although their use requires careful risk-benefit assessment and further validation in controlled trials.