Use of methotrexate in sarcoid-associated optic neuropathy

Ophthalmology. 2003 Mar;110(3):559-63. doi: 10.1016/S0161-6420(02)01889-4.


Objective: To demonstrate the possible beneficial effects of methotrexate (MTX) therapy for patients with sarcoid-associated optic neuropathy (SAON).

Design: Retrospective, noncomparative, interventional case series.

Participants: Three patients diagnosed with SAON who received MTX. Two patients had tissue biopsies consistent with sarcoidosis, and 1 patient had clinically diagnosed sarcoidosis based on laboratory and radiographic studies. All 3 patients developed side effects with corticosteroid treatment of their optic neuropathy.

Intervention: Patients were treated with weekly doses of oral MTX and monitored with neuro-ophthalmic, medical, and laboratory examinations.

Main outcome measures: Visual acuity, automated perimetry, and reduction of oral prednisone therapy.

Results: After initiation of MTX, all 3 patients showed an improvement or stabilization of visual acuity. All patients had a decrease in their corticosteroid requirements, and all had improved or stabilized visual field deficits. One of the 3 patients developed leukopenia that necessitated a reduction of the methotrexate dose.

Conclusion: Methotrexate may be effective for SAON as an adjunct to corticosteroid therapy or as an alternative for corticosteroid-intolerant patients. Oral MTX reduced the corticosteroid requirements of 3 patients with SAON, and all 3 demonstrated stable or improved visual function.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Female
  • Folic Acid Antagonists / therapeutic use*
  • Glucocorticoids / therapeutic use
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Magnetic Resonance Imaging
  • Methotrexate / therapeutic use*
  • Middle Aged
  • Optic Nerve Diseases / diagnosis
  • Optic Nerve Diseases / drug therapy*
  • Optic Nerve Diseases / physiopathology
  • Prednisone / therapeutic use
  • Sarcoidosis / diagnosis
  • Sarcoidosis / drug therapy*
  • Sarcoidosis / physiopathology
  • Visual Acuity
  • Visual Fields


  • Folic Acid Antagonists
  • Glucocorticoids
  • Immunosuppressive Agents
  • Prednisone
  • Methotrexate