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We present a 33-year-old man with a seven-year history of lid swelling, conjunctival chemosis and injection, and proptosis in both eyes. Enlargement of all extraocular muscles in both eyes was visualized on MRI. He did not respond to oral prednisone, although the symptoms and the signs resolved promptly with intravenous methyl-prednisolone given after orbital irradiation.

Six patients with generalized histologically confirmed sarcoidosis developed optic nerve involvement, two at the onset and four during the chronic course of the disease. Two patients had granulomata of the prelaminar part of the optic nerve, two patients had optic disc oedema with an unusual appearance, one had a retrobulbar optic neuritis and one a glaucomatous cupping of the optic nerve head. Four patients had no visual complaints at the time the sarcoid optic nerve abnormality was detected. The wide variety of the ophthalmos-copical appearance of the sarcoid optic nerve affection and the patients' neuro-ophthalmic and otherclinical findings is discussed. The fluoresceinangiography of thegranulomatosis of the optic nerve showed an early hypofluorescence typical of a sarcoid mass lesion.