Bilateral Orbital Tuberculosis with Unilateral Severe Irrversible Vision Loss in Children: A Case Report

Abstract

Introduction: Tuberculosis is a transmissible infectious disease caused by mycobacterium tuberculosis. Ocular tuberculosis is rare representing between 1% to 18% of all forms of tuberculosis and only 0.3% of patients develop the orbital form. The focus is usually unilateral, we report through this observation a case of bilateral orbital tuberculosis in a 12 year old girl. Observation: A 12-year-old girl was admitted to the department of infectious and tropical diseases of the National Hospital of Zinder for long term fever and violent headache. The ophthalmological examination revealed a visual acuity of 1/10 on the right, absence of light perception on the left and bilateral exophthalmos. Biomicroscopic examination showed superficial punctate keratitis bilaterally, a normal fundus on the right and left atrophy. In view of the long-lasting fever and the biological inflammatory syndrome, the diagnosis of tuberculosis was evoked. The tuberculin intradermal test (IDR) was positive and the search for BK in the bronchial lavage revealed BAARs. HIV serology was negative. The standard chest X-ray was normal but the CT scan of the orbito- cerebral cavity showed two cystic foci with grade III exophthalmos. After 3 months of anticillary treatment the evolution was considered satisfactory. Conclusion: The orbital involvement of tuberculosis was generally unilateral, its bilateral localization is unusual. It must be systematically evoked in front of any case of bilateral exophthalmos especially in an infectious context in order to avoid irrevesible vsion loss.