Tubercular Nodular Episcleritis: A Case Report

Abstract

A 30-year-old Indian male presented to our OPD with mild uniocular pain, redness, and blurring of vision, excessive lacrimation and photophobia of his right eye since one month. He also had associated right sided headache with lethargy and mild cough with sputum. It was his first episode and was no history of any trauma or any ocular surgery. He neither complained of any problem in his opposite eye nor gives history of any joint pain, dryness of mouth, fever or any other systemic illness. There was no history of use of any systemic or topical drugs prior to the illness. He does not give a history of tuberculosis in the family, however, he gave a history of tuberculosis in the neighbourhood, and details were not available. Also, there was no history of any other major medical or surgical intervention in the past. He was previously evaluated by an Ophthalmologist, but was finally referred to our hospital for further evaluation and management, as there were no signs of improvement. He was on the prednisolone (1%) eye drops four times a day, atropine (1%) eye drops two times a day and ofloxacin eye drops (0.3%) four times a day for three weeks.On examination, he had mild pain in right eye, however, he was conscious, co-operative and well oriented to time, place and person. He was thinly built and his body weight was 42 kg and his height was 158 cm. His vital parameters were within normal limits, including temperature of 98.4 0 F. Systemic examination, including respiratory and musculoskeletal system was reported normal by medical internist on consultation. Besides, there were no palpable lymph nodes in the body. His visual acuities in both eyes have always been 6/6. Lids and adnexa were normal. However, a pinkish nodule of about 3mm noted in the right eye, near the medial canthus from 3 'o'clock to 5 'o'clock position. This nodule was situated 3-4 mm from the limbus and was freely movable with the conjunctiva and episcleral tissue [Table/ Fig-1]. Also, a pinkish nodule of about 4 mm was noted in the right eye near the lateral canthus from 7 'o'clock to 10 'o'clock position [Table/ Fig-2]. This nodule was situated 1-2 mm from the limbus and was freely movable with the conjunctiva and episcleral tissue. The episcleral vessels on the same side were engorged and red. Intraocular pressure on Goldman Tonometer was normal in both eyes. There was no abnormality noted in cornea, iris, anterior and posterior chambers. He never saw any visual halos. Dilated fundus examination was normal. Slit lamp examination was suggestive of episcleral involvement. There was no involvement of sclera, uvea or cornea. Cotton swabs were taken and sent to a lab for bacterial culture and Acid Fast Bacilli (AFB) but were found to be negative. The biopsy was not attempted, to avoid possible Tuberculosis (TB) is an infectious disease caused by the acid-fast bacillus Mycobacterium tuberculosis and is an important cause of death worldwide. Tuberculosis most commonly affects the lungs, but has many extrapulmonary manifestations as well, including intra...

Scleritis: Differentiating infectious from non-infectious entities

“…Tuberculosis : Scleral involvement in tuberculosis can present as nodular anterior or posterior scleritis. [ 84 85 86 ] In a case series by Majumdar et al ., three patients had tuberculosis scleritis- one had bilateral necrotizing scleritis with posterior scleritis and two had nodular anterior scleritis. [ 86 ] Cheung and Chee[ 85 ] observed concurrent anterior uveitis in 75% of the patients with posterior scleritis.…”

Tuberculous scleritis in a young Asian Indian girl—a case presentation and literature review

“…In case series by Majumdar et al, three patients had tuberculosis scleritis-only one had bilateral necrotizing scleritis with posterior scleritis and two had nodular anterior scleritis [2]. Majority of the reported cases of scleral involvement in tuberculosis is nodular anterior scleritis [3,4]. Cheung and Chee observed concurrent anterior uveitis in 75% of the patients with posterior scleritis.…”

The novel concept of creating awareness about tuberculosis at the metro stations

“…Tuberculosis (TB) is a contagious disease which is now identified as a major public health concern in India, with millions of fatalities annually [ 1 ]. TB is caused by the acid fast bacillus Mycobacterium tuberculosis and is an important cause of mortality and morbidity worldwide due to its potential to affect any part of the human body including the lungs [ 2 , 3 ]. India has the largest burden of TB in the world, having approximately one-fifth of the global incidence [ 4 ].…”