|LETTER TO THE EDITOR
|Year : 2016 | Volume
| Issue : 7 | Page : 543-544
Comment on: A rare case of eyelid sarcoidosis presenting as an orbital mass
Charudutt Kalamkar1, Nishant V Radke2, Amrita Mukherjee3, Snehal Nishant Radke4
1 Department of Glaucoma, Orbit and Oculoplasty, Shri Ganesh Vinayak Eye Hospital, Raipur, Chhattisgarh, India
2 Department of Retina and Vitreous, Shri Ganesh Vinayak Eye Hospital, Raipur, Chhattisgarh, India
3 Department of Cataract, Anterior Segment and Charity Services, Shri Ganesh Vinayak Eye Hospital, Raipur, Chhattisgarh, India
4 Department of Cataract and Anterior Segment, Shri Ganesh Vinayak Eye Hospital, Raipur, Chhattisgarh, India
|Date of Web Publication||9-Sep-2016|
Shri Ganesh Vinayak Eye Hospital, Opposite Colours Mall, Dhamtari Road, Raipur, Chhattisgarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kalamkar C, Radke NV, Mukherjee A, Radke SN. Comment on: A rare case of eyelid sarcoidosis presenting as an orbital mass. Indian J Ophthalmol 2016;64:543-4
|How to cite this URL:|
Kalamkar C, Radke NV, Mukherjee A, Radke SN. Comment on: A rare case of eyelid sarcoidosis presenting as an orbital mass. Indian J Ophthalmol [serial online] 2016 [cited 2020 Jun 1];64:543-4. Available from: http://www.ijo.in/text.asp?2016/64/7/543/190170
With great interest, we read the article entitled, "A rare case of eyelid sarcoidosis presenting as an orbital mass" by Gaspar et al.  We have a few observations over which we request their comments.
The title of the article presents this case as an eyelid mass due to sarcoidosis whereas, in fact, the text describes it as an orbital mass seen through eyelid. The coronal contrast-enhanced computed tomography (CECT) demonstrates inferior extraconal orbital mass lesion. A sagittal section image would have been useful to evaluate extension of mass toward the lower eyelid. The intraoperative description also mentions the mass to be arising from orbital floor and not arising from lid tissues.
Sarcoidosis presenting as orbital mass is not uncommon. Orbital mass as presenting feature of sarcoidosis is found in up to 7% of patients. Orbital sarcoidosis commonly presents as palpable mass or as pseudotumor with inferior orbit being a common location of orbital sarcoidosis. , Most sarcoid lesions are found in extraconal anterior orbital space, which makes the lesion easily palpable or visualized early through the lid.  Eyelid involvement is described in 12-17% cases of orbital sarcoidosis. ,
We would like to know about the presence of any uveitis as the article fails to mention so. Uveitis is the most common finding of ocular sarcoidosis and has been demonstrated in 3-15% patients with orbital sarcoidosis. ,,
Consistency of lesion or any change in lesion size with Valsalva has not been mentioned as the authors considered primary differential being orbital varix. CECT classically demonstrates hyperintense enhancement in case of varix with increase in size with post-Valsalva maneuver. In case thrombosed varix is suspected, magnetic resonance imaging with contrast and magnetic resonance angiography is a better imaging modality to differentiate vascular and nonvascular pathologies.
We would like to know whether systemic steroid treatment was initiated modality after histological diagnosis of sarcoidosis. We agree with their advice of close follow-up since patients with orbital lesions as a presenting feature of sarcoidosis may develop systemic sarcoidosis or may have further progression of existing systemic lesions. 
Postsurgery clinical picture and radiological (CECT) images would have been helpful.
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Conflicts of interest
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| References|| |
Gaspar BL, Gupta K, Singh U. A rare case of eyelid sarcoidosis presenting as an orbital mass. Indian J Ophthalmol 2016;64:244-5.
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Orbital and adnexal sarcoidosis. Arch Ophthalmol 2007;125:1657-62.
Demirci H, Christianson MD. Orbital and adnexal involvement in sarcoidosis: Analysis of clinical features and systemic disease in 30 cases. Am J Ophthalmol 2011;151:1074-1080.e1.
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Outcome of the treatment for sarcoidosis. Am J Respir Crit Care Med 1994;149(4 Pt 1):893-8.