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   Table of Contents      
ARTICLES
Year : 1985  |  Volume : 33  |  Issue : 2  |  Page : 115-116

Tubercular tarsitis


Departments of Ophthalmology & Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:
K Mohan
Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


PMID: 3833735

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How to cite this article:
Mohan K, Prasad P, Banerjee A K, Dhir S P. Tubercular tarsitis. Indian J Ophthalmol 1985;33:115-6

How to cite this URL:
Mohan K, Prasad P, Banerjee A K, Dhir S P. Tubercular tarsitis. Indian J Ophthalmol [serial online] 1985 [cited 2019 Dec 10];33:115-6. Available from: http://www.ijo.in/text.asp?1985/33/2/115/30834

Tuberculous affection of lids, either primary or secondary is comparatively rare. However, when involved, the skin affection in the form of lupus vulgaris is the commonest mode of presentation.[1] The tarsus resists inflammation because of its, fibrous and avascular structure, hence tubercular involve­ment of tarsus is an extremely rare condition. This case of histologically as well as bacte­riologically proven tubercular involvement of tarsus merits reporting.


  Case report Top


J.K., 40 years female, presented to the eye Outpatient Department of PGIMER, Chandigarh with the history of repeated chalazion in all the four lids operated several times and now having a chalazion in her right lower lid which had already been operated eight times earlier. Examination revealed it to be a typical chalazion. Chalazion was subjected to incision and curettage. In the early post­operative period, patient had some residual induration of lid but three weeks after curettage, she presented with a large and diffuse lid swelling in the same area. Exami­nation at that time revealed a diffuse thicke­ning of the right lower lid with healthy over­lying skin. Conjunctival surface showed about 1 cm X 1 cm. diffuse mass with a large ulcerated area on its surface [Figure - 1]A. Ulcer had irregular and heaped up margins with necrotic material and discharge at the base. Right pre-auricular lymph node was enlarged and tender. Meibomian gland carcinoma was strongly suspected. Excision biopsy of the mass along with the tarsus was done and the tissue was subjected to histopathological examination which revealed a typical tuber­culous granuloma with Langhan's giant cells and caseous necrosis [Figure 3]. Special stains demonstrated scattered acid fast bacilli within the necrotic material. Investigations for tuberculosis revealed a positive Mantoux test (+27 mm), ESR-27 mm in the first hour and negative X-ray chest. Patient was put on Isozone forte, one tablet a day.

Following anti tubercular therapy, the granuloma disappeared completely but a symblepharon formed in that area. [Figure 3],


  Discussion Top


Tuberculous involvement of the tarsus is extremely rare[1],[2]. Primary tuberculosis of the tarsus has not yet been proved; however it may become secondarily affected from neighbouring diseased tissue. Involvement through haematogenous route may also occur rarely as has been demonstrated experimental ly[1]. When involved it usually presents with chalazion like masses as ha been reported by Gat et al[2]. Conjunctiva may be normal or may show an ulcerative lesion with livid and undermined edges. Overlying skin is usually healthy but may occasionally be involved, giving rise to scrofuloderma. Pre-auricular lymph node may be enlarged. Clinical diagnosis of tubercular tarsal granuloma is extremely difficult in cases presenting with chalazion like swellings because of similarity with usual chalazion. Frequent recurrence after subjecting these chalazia to usual incision and curettage diverts one's attention towards a more alarming condition of meibomian gland carcinoma as has happened in the present case and possi­bility of tubercular tarsitis was not entertai­ned at all. Moreover its clinical differentia­tion from meibomian gland carcinoma is extremely difficult though in patients with proven tubercular lymphadenitis or systemic tuberculosis, suspicion of tubercular etiology for lid lesion may arise. However, diagnosis is confirmed only histopathologically by demonstrating tubercular granulomatous picture and by demonstrating acid fast bacilli in the involved tissue. Granuloma usually resolves following general anti-tubercular therapy.


  Summary Top


An extremely rare case of tubercular tarsitis presenting as recurrent chalazion is reported. Possibility of tubercular tarsitis in addition to meibomian gland carcinoma in a patient with recurrent chalazion should be entertained seriously.

 
  References Top

1.
Duke Elder S. 1974, System of Ophthalmology Vol XIII, Part I, Page 104-108 & 237.  Back to cited text no. 1
    
2.
Gat, L. Pomit, and Gat, G., 1962. Ophthal­mologica, 144 : 175.  Back to cited text no. 2
    


    Figures

  [Figure - 1]


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