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Year : 1989  |  Volume : 37  |  Issue : 2  |  Page : 98

Bilateral tubercular lid abscess-a case report

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D K Mehta
26 Kotla Road, New Delhi-110002
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Tuberculosis is a ubiquitous disease and a public health problem of major importance in almost all countries. The disease can involve any part of the body. Eye involvement to tuberculosis is also common. A case of bilateral tuber­cular lid abscess without any active systemic involvement is being reported because of its rare occurance.

How to cite this article:
Mehta D K, Sahnikamal, Ashok P. Bilateral tubercular lid abscess-a case report. Indian J Ophthalmol 1989;37:98

How to cite this URL:
Mehta D K, Sahnikamal, Ashok P. Bilateral tubercular lid abscess-a case report. Indian J Ophthalmol [serial online] 1989 [cited 2023 Nov 30];37:98. Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?1989/37/2/98/26077

  Introduction Top

Ocular tuberculosis manifests in a number of ways involving virtually all the structures of the globe and even ad­nexa. Primary tuberculosis of the eye is known but often proven indirectly. The lacrimal glands, lacrimal sac, tarsal plate and lids are affected by tubercular infection. Tubercular abscess formation is a common occurrence in different parts of the body. Typically, a tubercular abscess, known as cold abscess, presents as a fluctuant soft mass with no signs of acute inflammation.

A tubercular abscess of the lid can be seen with underlying bone invovementl but bilateral involvement of the lids is far more rare [2],[3] . The present communcation deals with one such case in which a child had bilateral lower lid abscess without any other evidence of tuberculosis elsewhere in the body.

  Case Report Top

A 6 year old girl presented with mild inflammatory swellings of both lower lids. The general and systemic examinations were essentially within normal limits. Ocular examination revealed bilateral fluctuant and transilluminant abscesses with little erythema and tenderness, of the lower lids, the right abscess was pointing.

Under general anaesthesia, the right abscess was drained through a small horizontal incision in the line of the skin crease and about 8-1Oml of thick pus with blood staining was aspirated and sent for culture & sensitivity. A colony of staph, aureus was isolate and treated appropriately. After the initial response there was no progress and the wound showed a tendency to sinus formation. The pus was studied for Acid Fast Bacilli (AFB). Smear examination with Ziehl Nielson stain­ing was negative but culture was positive for tubercular bacil­li.

An X-Ray chest done depicted an enlarged hilar lymphnode with a small area of infiltration in the lower zone in the right lung. Sputum and blood culture were negative. The patient responded remarkably well to anti-tubercular treatment.

  Discussion Top

The above case report highlights the following features in a young child with a silent chest lesion.

  • Bilateral symmetrical involvement of the lower lids
  • Sparing of neighbouring structures
  • No apparent involvement of lymphatics
  • Confirmation of diagnosis was possible only after culture for Acid Fast Bacilli.

Donahul (1967) [2] after working in a Boston sanatorium for nearly 25 years failed to see any case of tubercular lie abscess. Watrin and Mendelsohn (1967) [1] reported a case of bilateral tubercular lid abscess but it was secondary to involvement of the maxillary sinus. No mention has been made in literature of isolated tubercular lid abscesses [3]

The aim of presenting a rare case of tubercular lid abscess is that one must be aware of tuberculosis as an underlying dis­ease in cases of poorly responding lid abscesses though the smear examination for AFB is negative. It becomes of more importance in tropical countries where tuberculosis is still a major health problem.

  References Top

Watxin & Mendelsohn. Bull. Soc. Ophth. Fr., 67:1124,1967  Back to cited text no. 1
Donahul H.C. Ophthalmology experience in T.B. Sanatorium American Journal of Ophthalmology, 64:742-8,1967.  Back to cited text no. 2
Duke Elder System of Ophthalmology Vil. XIII Part-I Henry Kimptioon, London, 1974.  Back to cited text no. 3


  [Figure - 1], [Figure - 2]

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