Bilateral, Anterior granulomatous uveitis, vitritis, vascular retinitis, and CN 7 palsies are ocular findings associated with what potential posterior uveitis etiology?

• A. Toxoplasmosis
• B. Sarcoidosis
• C. Cytomegalovirus
• D. Histoplasmosis

Answer: (B)

Bilateral granulomatous anterior uveitis with vitritis, retinal vascular inflammation, and facial nerve palsy points to sarcoidosis because this systemic granulomatous disease commonly involves the eye in both the anterior and posterior segments and can affect cranial nerves through neurosarcoidosis. The iris and ciliary body often show granulomatous inflammation leading to granulomatous anterior uveitis; inflammatory cells in the vitreous cause vitritis; involvement of retinal vessels produces vascular retinitis. Facial nerve palsy is a well-known neurologic manifestation of sarcoidosis, reflecting neurosarcoid involvement that can accompany ocular disease. In contrast, toxoplasmosis tends to be unilateral with focal retinochoroiditis, CMV retinitis occurs in immunocompromise with a different appearance, and histoplasmosis typically presents with chorioretinal scars rather than this concurrent mix of anterior and posterior involvement plus CN VII palsy.