Rare presentation of sarcoidosis with optic neuropathy and third nerve palsy

Sarcoidosis is a systemic, idiopathic and granulomatous disease, which most commonly affects the skin, lungs and lymph nodes but can affect virtually any organ. Neurosarcoidosis can be the presenting or the only clinical manifestation accounting for 5%–15% of sarcoid diagnoses. In contrast to uveitis which is the most common ophthalmic manifestation, neuro-ophthalmic signs are uncommon in sarcoidosis. Optic neuropathy is the most common neuro-ophthalmic sign (70% in one series). Sarcoid-related optic neuropathy commonly presents with a picture similar to optic neuritis. Less commonly, optic nerve involvement occurs secondary to compressive lesions, or from direct granulomatous infiltration. Neuroimaging is crucial to identify the location of the lesion. We describe a case of sarcoid-related compressive optic neuropathy and third nerve palsy and highlight the challenging nature of neurosarcoidosis in a patient without a prior diagnosis of the disease.

Lymphangioma Presenting as Sudden Proptosis in a Toddler

Orbital lymphangioma commonly occurs in the first decade of life. It is usually congenital, slow growing and can lead to orbital haemorrhage, ptosis, orbital cellulitis, proptosis and compressive optic neuropathy. A 14-months-old male child was brought to the eye clinic with sudden protrusion of the left eye for the past two days. On examination of left eye, a non-axial, non-pulsatile proptosis with ptosis and inferior eyelid ecchymosis were noted. Anterior segment and fundus were normal. Pupil was normal and reacted briskly to light. Intraocular pressure measured with Tonopen was 16 mm Hg. Right eye: anterior segment, fundus, and intraocular pressure were normal. Magnetic resonance imaging of orbits and brain showed left sided multicystic intraconal mass with area of haemorrhage. The diagnosis of left orbital lymphangioma was made. The initial treatment with Propranolol syrup did not reduce the proptosis. Left nasal endoscopic aspiration of blood and orbital decompression was done by the otolaryngologist. The child was followed up for one year and the proptosis was found to be reduced markedly on the left side. Although various modalities of treatment are available for this condition, unfortunately there are no definitive curative treatments currently. In view of its rarity, this case is reported.