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Sarcoid Posterior Uveitis — RACP Adult Medicine MCQ

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ModerateRheumatologySarcoid Posterior UveitisRACP Adult Medicine

A 55-year-old woman with sarcoidosis presents with bilateral chronic anterior uveitis and posterior uveitis (vitritis with snowball opacities). She has been on topical steroids but vision is declining. She has cystoid macular oedema on OCT. What is the most appropriate escalation?

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Correct answer: D — Oral prednisolone 40 mg daily

Posterior uveitis and intermediate uveitis (vitritis with snowball opacities) in sarcoidosis cannot be adequately treated with topical steroids alone (poor penetration to posterior segment). Systemic corticosteroids (oral prednisolone) are required. For steroid-sparing, methotrexate or adalimumab may be added. Cystoid macular oedema may also require periocular or intravitreal triamcinolone.

Reference: BTS – 2020 – Sarcoidosis; ARA/RANZCO 2024 Uveitis Guidelines