Choroidal white lesions as an early manifestation of sarcoidosis

Purpose: To describe the natural history of a series of patients with fine white choroidal lesions and uveitis of previously unknown cause. Methods: A retrospective chart review of 11 patients with chronic uveitis and multiple, small (50-100 μm), peripheral white lesions of the choroid was performed using a standardized questionnaire form. Results: Ten of 11 patients were white women with an average age of 62 years. Seven of 11 patients had panuveitis; 4 of 11 patients had vitritis; and 6 of 11 patients had cystoid macular edema. Choroidal white lesions were bilateral in all but one patient. Seven of 11 patients were followed up for more than 1 year. During a 12- to 173-month follow-up (mean, 94 months), these patients showed coalescence and atrophy of the white lesions. Initial systemic examination for the cause of the uveitis and white choroidal lesions was negative in all seven patients. With long-term follow-up, sarcoidosis was diagnosed in five of the seven patients followed for more than 1 year. Conclusions: The pattern of inflammatory white choroidal lesions distributed in the peripheral retina that atrophy and coalesce with time and that are associated with uveitis in middle-aged white women may represent an early form of sarcoidosis.