The earliest ocular manifestation of sarcoidosis that can be detected on slit-lamp examination even before systemic symptoms is:

• A Posterior synechiae due to anterior uveitis
• B Mutton fat keratic precipitates on the corneal endothelium
• C Band keratopathy from hypercalcaemia
• D Berlin's nodules (small nodules at the pupillary margin) ✓

Explanation

In sarcoidosis, the earliest iris nodules are Busacca nodules (in the iris stroma) and Koeppe/Berlin nodules at the pupillary margin. Koeppe/Berlin nodules are small, whitish granulomatous nodules at the pupillary margin visible on slit-lamp before major inflammation develops. Mutton fat KPs (large greasy KPs on inferior corneal endothelium) are pathognomonic of granulomatous uveitis including sarcoidosis but appear with established inflammation. The combination of mutton fat KPs, iris nodules, and snowball vitreous opacities ('string of pearls') is characteristic of sarcoid uveitis.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.