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| ARTICLES |
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| Year : 1981 | Volume
: 29
| Issue : 1 | Page : 47-49 |
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Sub-periostial tuberculoma of the left lateral wall of orbit
DL Maria, SH Mundada
Department of Ophthalmology Medical College, Aurangabad, India
Correspondence Address:
D L Maria
Department of Ophthalmology Medical College, Aurangabad
India
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 7287126 
How to cite this article:
Maria D L, Mundada S H. Sub-periostial tuberculoma of the left lateral wall of orbit. Indian J Ophthalmol 1981;29:47-9 |
Uveal involvement is known in tuberculosis, but tuberculosis of the orbit is rare.[1],[2],[3] The infection may reach the orbit by metastasis from a distant site or by extension from adjacent structures. The aim of this presentation is to document a rare case of subperiosteal tuberculoma which posed a diagnostic problem.
| Case report | |  |
A five years old female child was admitted with complaints of swelling on the upper and outer quadrant of the left orbit for the last three months. Parents of the patient gave the history that to start with there was a high grade fever with exacerbations and remissions in the swelling. There was no pain. The past history was not suggestive of tuberculosis. There was no history of B.C.C. vaccination. There was no history of tuberculosis in the family.
On admission child was febrile, pale and emaciated. Submandibular and cervical lymph nodes were palpable, which were non-tender and firm in consistency.
Examination of vertebral column revealed gibbus at the level of T 10, 11, 12. Fluctuation was positive and it was non-tender. There was no neurological deficit. In the lungs there was no evidence of tuberculosis. [Figure - 1]
Local Examination showed a cystic swelling about the hard-nut size present on the upper and outer quadrant of the left orbit. It was non-tender and fluctuations were present. It was not adherent to the skin. There was no fistula, no proptosis and eye ball movements were normal. There was slight ptosis leading to narrowing of the palpebral aperture. Cornea, anterior chamber and iris were normal. Fundus was normal. Right eye did not reveal any abnormality. A provisional diagnosis of tuberculous swelling of the left lateral wall of the orbit was made.
Investigations showed Haemoglobin : 8.4% E.S.R. : 62 mm. at the end of first hour; Mantoux Test : Positive (13-14 mm. induration) X-Ray Chest : NAD; X-Ray Skull : NAD, X-Ray Spine : Pot's spine T 10, 11 with cold abscess and Stool Examination : Round worm ova were detected.
Operative Notes : Under general anaesthesia patient was taken up for exploration with a localised skin incision, periost urn was cut and lifted. A yellowish white cystic swelling was seen beneath it. During dissection it got ruptured and pultaceous, necrosed and caseous material came out.
Swelling was extending quite posteriorly along with the lateral orbital margin. Whole of the caseous material was removed. A slight erosion of the lateral wall of orbit was seen. Streptomycin powder was instilled and incision was closed with a drainage tube. Caseous material was sent for histopathology and report came as tuberculous granule lion tissue showing typical epitheloid and giant cells [Figure - 3] Post operatively child was put on streptomycin injection 1/2 gm., tablet I.N.H. 150 mg. daily with multivitamins and high protein diet. Postoperative period was uneventful, child was discharged after 15 days with an advise to continue streptomycin injections upto 90 days and tablet I.N.H. for about 1 years [Figure - 4]
| Discussion | | |
Most of the chronic inflammatory lesions of the orbit are of unknown etiology. Clinically these inflammations are mistaken for neoplasm hence these are termed as orbital pseudotumors. Chronic inflammation is usually nongranulomatous. The clinical manifestation and course of such conditions vary widely. The orbit is rarely involved by truly granulomatous inflammatory lesion and tuberculous involvement is particularly rare.
Tuberculosis of the orbit may be primary in origin due to metastasis giving rise to marginal or deep periostitis or tuberculoma of the orbital tissue or secondary due to direct extension form neighbouring structures. Tuberculous periostitis mostly affect the outer orbital margin particularly in the region of malar bone. Tuberculoma of the orbit is more rare wherein a mass of chronic granulomatous tissue of a tuberculous nature appear in the orbit due to haematogenous infection. It usually affects adults between 40 to 50 years but the present case was a child of 5 years with previous Pot's disease of spine as another focus. This runs a slow and insidious course with proptosis but in this case there was neither proptosis nor limitations of movements because it was subperiosteal involving orbital margin.
| Summary | | |
A rare case of subperiosteal tuberculoma of lateral wall of the orbit has been reported.
| References | | |
| 1. | Reese, Algernon B., 1963, Tumours of the Eye 2nd Ed. P. 544  |
| 2. | Duke Elder, S., 1963, : Ocular Adnexa Part II System of Ophthalmology, Vol. XIII, P. 902, Henry Kimpton, London |
| 3. | Hogan, M.J. and Zimmerman, L.E., 1962, An Atlas and Text Book of Ophthalmic Pathology, 2nd Ed., P. 728. |
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]
| This article has been cited by | | 1 |
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| Madge, S.N., Prabhakaran, V.C., Shome, D., Kim, U., Honavar, S., Selva, D. | | Orbit. 2008; 27(4): 267-277 | | [Pubmed] | | | 2 |
Orbital tuberculoma extending into the cranium |
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| Dewan, T., Sangal, K., Premsagar, I.C., Vashishth, S. | | Ophthalmologica. 2006; 220(2): 137-139 | | [Pubmed] | | | 3 |
Orbital tuberculosis with abscess |
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| Aggarwal, D., Suri, A., Mahapatra, A.K. | | Journal of Neuro-Ophthalmology. 2002; 22(3): 208-210 | | [Pubmed] | |
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