This study investigates the thickness of retinal structures in patients with neurosarcoidosis (NS) and ocular sarcoidosis (OS). We compared the central macular thickness (CMT), retinal thickness (RT), central nerve fiber layer (RNFL) thickness, and ganglion cell layer (GCL) thickness using optical coherence tomography. In a cross-sectional study, we categorized 97 sarcoidosis patients (185 eyes) into four groups: patients without ocular or central nervous system sarcoidosis (Non-Ocular/Non-CNS, n = 53), patients with OS (Ocular, n = 13), patients with NS (CNS, n = 16), and patients with combined OS and NS (Ocular/CNS, n = 15). The mean age was 51 (14) years. We found no overall difference between the groups in the CMT (p = 0.3), RT (p = 0.9), RNFL (p = 0.3), and GCL measurements (p = 0.9). Only in patients with a disease duration of more than five years, the CMT was significantly thicker in the Ocular group (278 μm, p <
0.001), the CNS group (267 μm, p = 0.04), and the Ocular/CNS group (268 μm, p = 0.04), compared to the Non-Ocular/Non-CNS group (249 μm). The RT was significantly thicker in the Ocular group (296 μm, p = 0.008) and the Ocular/CNS group (291 μm, p = 0.03) compared to the Non-Ocular/Non-CNS group (283 μm). In the RNFL measurements, the Ocular group (33.7 μm, p = 0.002) was thicker than the Non-ocular/Non-CNS group (29.1 μm). We found an increased retinal thickness in patients with ocular sarcoidosis and long disease duration.