Keratoconjunctivitis sicca due to sarcoidosis.

SARCOIDOSIS is well recognized as a cause of swelling of the lacrimal glands and enters into the differential diagnosis of tumours of this region (DukeElder, 1952). Such swellings may be followed, in some cases, by a form of keratoconjunctivitis sicca (Ainslie and James, 1956; Gruber, 1956). The association of systemic sarcoidosis with keratoconjunctivitis sicca in the absence of swelling of the lacrimal glands has also been described (Ainslie and James, 1956; James, 1956; Ramage and Kinnear, 1956), but in these cases the histology of the ocular lesions was not obtained; it was presumed, however, that they were of the same pathology. In the case to be described, a patient, who had been treated in an ophthalmic clinic for 3 years for symptoms of conjunctival irritation, was found on mass radiography of the chest to have the typical radiological features of sarcoidosis. In view of this finding the patient was referred, after proof of systemic sarcoidosis had been obtained by liver biopsy, for investigation of her ocular condition. The patient's eyes lacked the generally accepted features of ocular sarcoidosis, namely swelling of the lacrimal glands, yellowish conjunctival follicles (Crick, Hoyle, and Mather, 1955; Crick, 1956), or chronic uveitis, but presented the clinical features of keratoconjunctivitis sicca. In addition she had complained of dryness of the nose and throat. Biopsy of lacrimal gland and conjunctiva, however, revealed that the ocular disorders were in fact due to sarcoidosis.