Purpose To present the clinical evolution and diagnosis of a patient with binocular and no simultaneous affection of posterior synechiae, associated to bombe iris and neovascular glaucoma, without medical treatment response. Methods Clinical case: A 63 year-old male is assisted in the ER because of progressive and painless visual loss in his left eye; visual acuity was only light perception. Anterior segment (AS) showed a synechia, ambarin atypical membranous tissue and neovascularization in the pupillary area, causing an iris bombe with no acute inflammatory signs and an IOP of 60 mmhg. Ocular sonogram and ultrasound bio microscopy didn't show tumor growth. The treatment with anti-inflammatory, hypotensive and mydriatic eye drops could not break the synechiae nor reach normal IOP. One year later, the patient came to the ER because of right eye visual loss. AS showed a similar synechial tissue, no tyndall effect and IOP of 20 mmhg. Due to the left eye experience, we decided to practice surgery in the right eye. Results We took aqueous humor sample + synechiotomy + iridian biopsy + phacoemulsification with IOL. 20/20 visual acuity after surgery. After many medical tests and the anatomopathological study, the patient was released from the hospital with probable pulmonary and ocular sarcoidosis. Conclusions If we have a patient with atypical progressive posterior synechiae without inflammatory signs and with no treatment response, we should think about sarcoidosis ocular as the diagnosis. Our experience shows that an early surgery is the most effective option to avoid blindness in these cases.