Consultant, Uveitis Service Paediatric Uveitis Dr. Rathinam Sivakumar HOD - Uveitis Services Dr. Radhika. T Consultant, Uveitis Service Dr. Vedhanayaki Rajesh

Ocular History 6 year old girl redness and pain (OU) since 1 month no H/O decreased vision similar episodes in the past

General History anti-TB-treatment due to suspected primary complex diagnosed outside to have juvenile idiopathic arthritis adequate treatment Methotrexate 5mg OD Prednisolone 5mg 1-0-1 Syp. Osteocalcin

First Presentation moderately built and nourished. swelling of knee the small joints OU: conjunctival granulomas diffuse granulomatous KP's AC - quiet 360º posterior synechiae AVF – quiet; disc and vessels normal

Conjuctival granulomas Granulomatous KPs

First Presentation Skin lesion flat-topped papules on the face, trunk, and extremities

Investigations TC : 8600 cells/cu.mm N-54; L-44; E-02 ESR: 1h: 10mm ACE: 73.2 IU (normal up to 53 IU) Mantoux and ANA: negative conjunctival biopsy: stratified squamous epithelium with lymphocytic infiltration suggestive of sarcoid chest X-ray: within normal limits.

Diagnosis Pediatric sarcoidosis induced uveitis Preschoolers present with the triad of arthritis, uveitis, and a cutaneous eruption of discrete small papules treated with steroid and resolved.

Differential Diagnosis JRA with uveitis ? Tuberculosis with uveitis ? Ocular sarcoidosis ?

_ Against Negative ANA Positive Poly articular involvement Conj .Granuloma B/L Granulomatous uveitis Sarcoid TB JRA Factors

Elevated ACE Positive Against Response to steroids +/_ Normal ESR _ Negative Mantoux - Elevated ACE SARCOID TB JRA

Treatment topical corticosteroids systemic corticosteroids methotrexate and folic acid she responded well to corticosteroids complete remission in 4 months

Conclusion Sarcoidosis is a multisystem granulomatous disease ocular involvement in 26% to 50 % signs of ocular sarcoidosis conjunctival granuloma anterior uveitis: mutton fat KPs; iris nodules

Conclusion Vitritis, Panuveitis, Retinal vasculitis Optic nerve involvement Choroidal nodules, exudative retinal detachment Cystoid macular edema "Candle wax drippings", "punched-out" lesions Lacrimal gland enlargement with Dry eye NLD stenosis or total obstruction Granuloma in soft tissues of orbit/extra ocular muscles