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| CASE REPORT |
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| Year : 1992 | Volume
: 40
| Issue : 3 | Page : 90-91 |
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Tuberculoma of orbit
Mehra K S, Pattanayak S P, Saroj Gupta
Institute of Medical Sciences, B.H.U, Varanasi- 221005, India
Correspondence Address:
Mehra K S
B-54, IFS Colony, Mayur Vihar-Phase-I, DELHI-110091
India
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 1302233 
An interesting case of tuberculoma of the orbit, involving the whole of the eyeball with other orbital cavity structures, is being presented. This is very rarely seen in clinical practice.
How to cite this article:
MehraK, PattanayakS, Gupta S. Tuberculoma of orbit. Indian J Ophthalmol 1992;40:90-1 |
| Introduction | |  |
Orbital involvement in tuberculosis itself is a rare entity. Further tuberculous lesions involving the whole of the eyeball with orbital contents is still very rare.
An interesting case of tuberculorna of the eyeball along with orbital contents is being reported.
| Case report | | |
A girl, aged 16 years, presented with a large fungating mass protruding from the right orbital cavity of three months duration (Photo No. 1 & 2). Three months before she came to the hospital she developed redness of the right eye with slight swelling which progressed rapidly till she came to the hospital with a large fungating mass present. The patient did not give any history of general ailment in the past.
| CLINICAL EXAMINATION: | | |
Right Eye. P.L. absent.
Oedema of lids present. A fungating dark brown mass protruding out of the palpebral fissure was present (Photo 1, 2) The central area of the mass was ulcerated with a dirty yellowish discharge. Mass was 3 cms x 2 cms in size. It was hard in consistency, had irregular margins and did not bleed to touch. The mass was. immobile and was occupying the whole of the orbital cavity. The cornea or other structures of the eyeball could not be made out.
Left Eye. VA-6/6, No abnormalities detected.
Cervical glands were enlarged on the right side. Systemic exam-Bilateral axial adenopathy was present.
| Investigations | | |
Blood exam - HB-9.5%, Total W.B.C 10,000, P 59 L 35 E 6, ESR-30mm (Wintrobe Corrected) X-Ray skull showed soft tissue present in right orbital cavity.
Chest X-Ray showed healed primary tuberculous lesion. Mantoux test strongly positive.
Right orbital orbitotomy under G.A. was done. It was observed that all the orbital structures were adherent and the whole of the orbital cavity was occupied by one single brownish mass. The mass was removed.
| Histopathology report | | |
Gross - Specimen comprised of an irregular mass of 4.5 x 4 x 3 cms. No distinctive eyeball structures could be made out. On cutting distinction between anterior and posterior chambers was lost and entire tissue was replaced by grayish necrotic material with blackish gray areas in between. Optic nerve was not discernable.
| Microscopic | | |
The tissue was lined by stratified squamous epithelium with portion of discernable Descemet's membrane. Entire mass showed chronic granulation tissue with epithelial cell granuloma and Langhans type of giant cells consistent with tuberculosis. Hence a diagnosis of tuberculoma of the eyeball was made. Lymph node biopsy showed a nodular tissue of 2 cms. The cut surface showed extensive caseous necrosis. Microscopically the lymph mode showed extensive caseation with characteristic granulomatous picture consistent with tuberculosis.
| Discussion | | |
The most frequent type of tuberculous involvement in the eye is cyclitis. This cyclitis may become massive involving all coats of the eye and may simulate panophthalmitis or may result in severe endophthalmitis. Primary intraocular focus of disease may be in the ciliary body with rupture of the granuloma into the posterior chamber and further involving adjacent structures. Necrotising granulomas may lead to perforation of cornea, limbus and sclera. Among the other common ocular lesions of tuberculous etiology are interstitial keratitis, cold abscess of the orbit, discharging sinuses and chronic corneal ulcer. Usually tuberculoma of the orbit appears as an orbital space occupying lesion giving rise to proptosis and limitation of eye movement. In ophthalmic literature tuberculous lesions involving the intraocular structures or extraocular tuberculous lesions of the orbit have been described, but tuberculous lesions affecting the eyeball along with extraocular orbital structures together have not been described to a great extent. In our reported case it appears that most probably first it was the intraocular lesion which on spread gave rise to perforation of either the cornea/limbus/sclera leading to involvement of extraocular structures, resulting in one big orbital mass[2].
| References | | |
| 1. | Mehra KS et al - Cold abscess in the orbit - Acta. Ophthal-1968, 1067-1072  |
| 2. | Mortada, A - Brit. J. Ophthal. 1971, 55, 565 |
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6]
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