Managing periocular sarcoids

Periocular sarcoids can be seen in a variety of forms. Six clinical presentations of sarcoid lesions have been described: occult (Figure 1), verrucose (Figure 2), nodular (Figure 3), fibroblastic (Figure 4), mixed (Figure 5) and malignant/malevolent (Figure 6) (Knottenbelt and Kelly, 2000). In reality, the majority of cases have features of more than one form of sarcoid, i.e. are mixed lesions (Figures 7 and 8). Nodular lesions may take several forms: those that are clearly demarcated, which frequently become ulcerated in their later stages (Figure 9); and those that are more invasive and extensive, have less obvious margins and may occur in the upper or lower eyelid (Figures 10 and 11). The treatment options for periocular sarcoids vary with the location and type of sarcoid, and no one treatment is universally appropriate (Table 1). Many treatments are expensive and time consuming, and some have additional potential health and safety implications that are often overlooked or glossed over in equine veterinary practice, but should be considered prior to choosing a treatment modality. ‘Benign neglect’ of a periocular sarcoid lesion is a misnomer, as leaving them is not a benign procedure. In a series of 42 periocular lesions that were not treated when first examined, all 42 lesions required treatment at a later stage, and in 64% of these cases the lesions were too extensive to treat following referral, leading to the euthanasia of the horse (Knottenbelt and Kelly, 2000).