endophthalmitis. There is often little external evidence of inflammation. Patients may present with leukocoria, strabismus, or decreased vision. These are also common presenting symptoms of retinoblastoma, which must be differentiated from ocular toxocariasis. Although enzyme-linked immunosorbent assay (ELISA) titers for Toxocara species have a high sensitivity and specificity and are useful in diagnosing this disease, a positive laboratory finding does not eliminate the possibility of retinoblastoma, as elevated titers may be found in a significant percentage of the general pediatric population.

Figure 24-3 Toxocariasis, right eye. A, Distortion of posterior pole vessels. B, Peripheral granuloma.

Treatment includes observation of peripheral lesions, periocular or systemic steroids for posterior lesions and endophthalmitis, or surgical intervention to address retinal traction, cataract, glaucoma, or cyclitic membranes. Systemic antihelmintics are not useful in treating ocular toxocariasis, as the organism producing the inflammation is already dead.

Woodhall D, Starr MC, Montgomery SP, et al. Ocular toxocariasis: epidemiologic, anatomic, and therapeutic variations based on a survey of ophthalmic subspecialists. Ophthalmology. 2012;119(6):1211–1217.

Panuveitis

Sarcoidosis

Sarcoidosis may present in 2 distinct forms in children. In young patients (<5 years), lung disease is rare and sarcoidosis is more often characterized by the triad of uveitis, arthritis, and rash. Early-onset sarcoidosis is considered a pediatric granulomatous arthritis and is phenotypically and genetically similar to Blau syndrome (see discussion in next section). Older children (8–15 years) have the pulmonary abnormalities and lymph node findings more commonly associated with the adult form of the disease and are at risk for uveitis. Although anterior uveitis (Fig 24-4) is the most common manifestation of ocular sarcoidosis in children, this disease can produce a panuveitis.