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Sarcoid optic neuropathy

Division of Neurological Surgery (Dr. Gudeman) and the Departments of Neurology and Ophthalmology (Drs. Selhorst and Way bright), Medical College of Virginia, Richmond, VA, and Winter Haven, FL (Dr. Susac).

Three patients presented with unilateral progressive optic neuropathy. None of these patients had signs or symptoms referable to the chiasm or eye, thus confining their decline in vision to the optic nerve. Clinical and neuroradiographic evidence suggested a meningioma involving the optic nerve at the orbital-canalicular junction in one patient and the intracranial optic nerve in another patient. Surgical exploration in both patients, however, revealed a noncaseating granuloma. Decline in vision from granulomatous invasion of the retrobulbar optic nerve is an uncommon manifestation of sarcoidosis. Review of our patients' findings suggests that a nonsurgical diagnosis of sarcoid optic neuropathy may have been tenable.

Address correspondence and reprint requests to Dr. Gudeman, Medical College of Virginia, Box 631, MCV Station, Richmond, VA 23298.

Accepted for publication October 28, 1981.

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