Phaeochromocytoma with Sustained Hypertension
Authors: K. N. V. Palmer, G. A. McDonald
Journal: BMJ (1956)

OCULAR SARCOIDOSIS BSH 957 cells in the anterior chamber.There were no posterior synechiae.The patient had generalized glandular enlarge- ment and numerous skin lesions.A skin biopsy confirmed the diagnosis of sarcoidosis.Local cortisone treatment was given in the form of drops to both eyes, with in addition three subconjunctival injections of 6.25 mg. each to the right eye.There was rapid improvement in the vision with the disappearance of the precipitates.Three weeks after the start of treatment vision was 6/6 in both eyes.At the time of writing the patient's vision was still 6/6, but it had not yet been possible to stop applying drops, for cessation of treatment was at once followed by recurrence of inflammatory signs.Until three months previously, she was using cortisone drops, 0.5%, which she had to apply five times a day to keep the condition under control.For the last three months she had been using hydrocortisone drops, 1%, and twice- daily application of this had kept the iridocyclitis con- trolled.She has also had two courses of systemic corti- sone therapy to control her generalized sarcoidosis during periods of exacerbation. Treatment of Other Ocular SignsWith regard to the conditions other than iridocyclitis, no ocular treatment was given to the patient with Eales's disease or to the patient with macular oedema.The former's condition has remained stationary for two years, while that of the latter subsided spontaneously over a period of three months.The case of phlyctenular con- junctivitis was treated with atropine and sulphacetamide drops, clearing up after three weeks.Of the cases of keratoconjunctivitis sicca two were mild, though there was definite reduction in the quantity of tear secretion, as indi- cated by Shirmer's test, and early filiform keratitis was present in each case.Symptomatic treatment, using Ringer-Locke solution, sulphacetamide, and methyl cellu- lose drops, brought considerable relief.One of these patients had moderately enlarged lacrimal glands, which returned to normal size over a period of eight weeks.The third case had much-enlarged lacrimal glands, severe filiform keratitis, and much-reduced lacrimation.The enlarged glands subsided to normal size spontaneously after three months.The only beneficial treatment in this case was hydrocortisone drops applied to the conjunctival sac.These brought great symptomatic relief.No treatment was effective in reducing the swelling in the case with infiltration of the eyelids, though systemic cortisone, local radiotherapy, and excision of the sub- cutaneous tissue were tried.Summary Of 100 patients with histological evidence of sarcoid- osis 28 had ocular abnormalities.Iridocyclitis, the most serious manifestation, was present in 20 cases.If untreated, sarcoid iridocyclitis may lead to blindness.Early treatment of the iridocyclitis with cortisone or hydrocortisone offers the best chance of controlling the disease.Treatment is unlikely to be beneficial when started at a late stage.Early diagnosis is therefore essential.Methods which assist in arriving at the diagnosis of sarcoidosis are discussed and a brief description of the Kweim antigen test is given.