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ARTICLES
Year : 1974  |  Volume : 22  |  Issue : 2  |  Page : 36-37

Sclerolytic granulomatous uveitis


Department of Ophthalmology, Jawaharlal Institute of Post-Graduate, Medical Education & Research, Pondicherry, India

Correspondence Address:
G C Sood
Department of Ophthalmology, Jawaharlal Institute of Post-Graduate, Medical Education & Research, Pondicherry
India
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Source of Support: None, Conflict of Interest: None


PMID: 4461693

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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 2021 Jan 26];22:36-7. Available from: https://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 Top


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 Top


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 . [2],[4] Colin Walker [1] 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 Top


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 Top

1.
Colin Walker, 1967, Brit. J. Ophthal, 51, 256.  Back to cited text no. 1
    
2.
Duke Elder S. and Perkins, E. S. 1966, System of Ophthalmology, IX, 267, Henry Kimpton, London.  Back to cited text no. 2
    
3.
Sorsby A. 1963, Modern Ophthalmology, II, 125, Butter worths, London.  Back to cited text no. 3
    
4.
Woods A.C. 1961, Endogenous, Inflammations of the Uveal Tract 71. The William and Wilkins Company, Baltimore, Marylard.  Back to cited text no. 4
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]



 

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