The most common causes of orbital disease in South India are inflammatory (34.1%) and systemic conditions (31.0%). With the exception of higher incidence of inflammatory etiologies, these data are largely consistent with prior published reports.

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Ultrasonography contains a wide selection of clinical indications. For instance, when examining a patient with ocular discomfort or pain, clinicians will use ultrasound to ensure a diagnosis of inflammation, orbital myositis, or dacryoadenitis. Imaging is often used to identify retrobulbar tissue, as well as the extraocular muscles, in patients with symptoms and suspected soft tissue enlargement secondary to Graves’ disease. There are various forms of diseases that involve the orbit and therefore the discussion of those disorders are often organized in line with the etiology (e.g., infection, inflammation, neoplasm) or by anatomic location.

Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae, clinically present either as tuberculoid, borderline or lepromatous type. Erythema nodosum leprosum (ENL) is an acute humoral response in the chronic course of lepromatous leprosy. Although very severe ENL reactions are known in systemic leprosy, such severity is rare in ocular tissues. A leprosy uveitis patient suffered from a severe form of post- therapeutic ENL reaction which resulted in perforation of the globe at the site of preexisting subconjunctival leproma. Painful blind eye was enucleated. Histopathological study revealed infiltration of numerous polymorphs and macrophages packed with acid-fast bacilli in the conjunctiva, cornea, ciliary body, ora serrata and sclera. A profuse influx of neutrophils on a background of macrophages packed with M. leprae confirmed the ocular ENL reaction. This case is reported to alert the ophthalmologists to a rare ocular complication of ENL.

Knowledge of the incidence and distribution of inflammatory responses can help clinicians understand orbital disorders, and establish standard protocols for appropriate treatments, including those conditions that warrant immediate attention 1 . The orbital compartment contains a variety of tissues arranged in a fashion reminiscent of Pandora’s box. These tissues can be independently involved in a plethora of disorders which can impose a number of sight-threatening risks. Many prior studies of these matters have laid a foundation for understanding the approximate incidence of various orbital pathologies 1-15