Sir,

Sarcoidosis is a multisystem granulomatous disease. It frequently affects young adults, with a female preponderance and commonly presents with respiratory, dermatological, or eye symptoms. One of the commonest presentations to the Eye department in patients with sarcoidosis is of acute anterior uveitis. We present a case of lash poliosis and anterior uveitis in a patient with sarcoidosis. We believe it to be the first reported case of poliosis associated with ocular sarcoidosis.

Case report

A 50-year-old Asian woman presented to Rheumatology department with an itching left calf and swelling in the right calf. An incision biopsy demonstrated granulomatous inflammation on histology. A chest radiograph showed appearances consistent with sarcoidosis. Her serum ACE was elevated at 119 IU/l and a diagnosis of sarcoidosis was made.

She was commenced on oral prednisolone 30 mg o.d. and referred to Ophthalmology department to screen for eye involvement.

At the Ophthalmic outpatients department she complained of itchy eyes. There were no other associated symptoms. Examination revealed no lacrimal gland swelling or lid margin granulomata. She had eyelash poliosis bilaterally (Figure 1). The tear breakup times were reduced at 2 s bilaterally. The right eye demonstrated keratic precipitates and cells in the anterior chamber. Her intraocular pressures were normal. There was mild inflammatory activity in the right anterior vitreous; however, both retinae were normal.

Figure 1
figure 1

Eyelash poliosis.

Full size image

She was diagnosed with dry eyes and right anterior uveitis, and commenced on topical steroids and artificial lubricants.

Discussion

Poliosis is the depigmentation of hair and has been described previously in association with several inflammatory conditions including idiopathic uveitis, Vogt–Koyanagi–Harada (V–K–H) syndrome, vitiligo, Marfan's syndrome and tuberous sclerosis.1, 2, 3

The ocular manifestations of sarcoidosis are well documented and include lid granulomata, lacrimal gland involvement, conjunctival follicles, episcleritis and scleritis, anterior uveitis, cataract, vitritis, choroiditis, periphlebitis, and retinal granulomata among others.

Sarcoidosis is also known to be associated with vitiligo, as are other granulomatous inflammatory diseases such as V–K–H syndrome.1, 2, 3 There is considerable overlap between various conditions involving ocular inflammation and depigmentation of both skin and hair.

It has been postulated that depigmentation is the result of an autoimmune mechanism. In sarcoidosis and V–K–H syndrome, there is overactivity of CD3 and increased expression of cytokines IL-1β, IL-2, IL-6, and TNF-α. This leads to T-helper cell differentiation and subsequent activation of T-cytotoxic cells and B cells, the latter producing circulating antibodies that attack melanocytes, thereby causing failure of pigmentation.4, 5

To the best of our knowledge there have been no prior reports of an association between sarcoidosis and poliosis in the literature. We suggest that in cases of uveitis seen with poliosis, immediate investigations should specifically include those directed to elicit the presence of sarcoidosis, which may require systemic therapy.