|Year : 1974 | Volume
| Issue : 2 | Page : 36-37
Sclerolytic granulomatous uveitis
GC Sood, AL Aurora, S Ramamurthy, M Mahabaleswara
Department of Ophthalmology, Jawaharlal Institute of Post-Graduate, Medical Education & Research, Pondicherry, India
G C Sood
Department of Ophthalmology, Jawaharlal Institute of Post-Graduate, Medical Education & Research, Pondicherry
|How to cite this article:|
Sood G C, Aurora A L, Ramamurthy S, Mahabaleswara M. Sclerolytic granulomatous uveitis. Indian J Ophthalmol 1974;22:36-7
|How to cite this URL:|
Sood G C, Aurora A L, Ramamurthy S, Mahabaleswara M. Sclerolytic granulomatous uveitis. Indian J Ophthalmol [serial online] 1974 [cited 2013 May 25];22:36-7. Available from: http://www.ijo.in/text.asp?1974/22/2/36/31368
Lysis of sclera leading to perforation is rare in uveitis. Recently we came across a case where a large scleral perforation was seen in a case of granulomatous uveitis which was mistaken for ciliary body tumour. On account of the rarity of the condition it was thought pertinent to report the case.
| Case Report|| |
A 65 years old male attended the Ophthalmic outpatient department of the JIPMER Hospital, Pondicherry with complaints of pain, redness and defective vision of the right eye of 20 days duration. There was no history of injury or such previous attacks in either eye.
General Examination:-The patient was of an average built and nourishment. He was afebrile and non-toxic. There was no significant lymphadenopathy. Cardiovascular and respiratory systems were clinically normal. Liver and spleen were not palpable.
Ocular Examination :- Right eye presented a round purplish nodule 14 mm x 15 mm in size at 11 O'clock position near the limbus [Figure - 1]. It was tender, soft and compressible. The conjunctiva over the nodule was ulcerated, the sclera was eroded and the edge of the scleral rim was seen all around the nodule. The eye showed marked ciliary congestion, the cornea being hazy and iris discoloured. Pupil was pinpoint and other inner structures could not be seen. Slit lamp examination revealed aqueous flare with multiple mutton fat and medium sized keratic precipitates on the back of cornea. The intraocular pressure was digitally high. The perception of light was absent.
The left eye was normal except for senile immature cataract. A provisional diagnosis of ciliary body tumour with extraocular extension was made, while possibility of scleromalacia perforans was also kept in mind.
All haematological investigations were normal. Mantoux test was strongly positive with induration of 22 mm. X-ray chest showed a doubtful haziness of the right apex.
Since the eye was painful and blind with the possibility of ciliary body tumour, it was enucleated and sent for histopathological examination. Post-operative period was uneventful.
Histopathological report :- Histology of the eye ball showed an area of perforation in the region of the limbus with evidence of expulsive haemorrhage. The later had caused the prolapse of the retina through the perforation [Figure - 2]. There was extensive cyclodialysis, detachment of choroid and retina. In the region of perforation, a fair number of non-caseating tuberculous granulomas were seen in the sclera [Figure - 3]. Similar granulomas were also present in the iris, ciliary body, choroid and retina [Figure - 4],[Figure 5],[Figure 6]. No acid-fast bacilli or fungus could be demonstrated. The histological picture was that of tuberculous chorio-retinitis, iridocyclitis and scleritis.
| Discussion|| |
In chronic inflammatory diseases of the eye, perforation of sclera in uncommon. Occurance of ocular perforation in tuberculosis is rare and as such few cases have been reported . , Colin Walker  described a case of conglomerate tuberculosis of iris leading to scleral perforation. The diagnosis was presumptive made on clinical grounds only and lacked histopathological evidence. In the present case the diagnosis was confirmed by histopathological examination.
| Summary|| |
A case of tuberculous granulomatous uveitis which caused a large scleral perforation is reported. The case was mistaken for ciliary body tumour with extraocular extension.
| References|| |
|1.||Colin Walker, 1967, Brit. J. Ophthal, 51, 256. |
|2.||Duke Elder S. and Perkins, E. S. 1966, System of Ophthalmology, IX, 267, Henry Kimpton, London. |
|3.||Sorsby A. 1963, Modern Ophthalmology, II, 125, Butter worths, London. |
|4.||Woods A.C. 1961, Endogenous, Inflammations of the Uveal Tract 71. The William and Wilkins Company, Baltimore, Marylard. |
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]