Year : 1953 | Volume
: 1 | Issue : 2 | Page : 64--66
Tuberculoma of the optic nerve
Medical College, Nagpur, India
K R Keshwachar
Medical College, Nagpur
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Keshwachar K R. Tuberculoma of the optic nerve.Indian J Ophthalmol 1953;1:64-66
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Keshwachar K R. Tuberculoma of the optic nerve. Indian J Ophthalmol [serial online] 1953 [cited 2022 Jan 25 ];1:64-66
Available from: https://www.ijo.in/text.asp?1953/1/2/64/40801
Chindibai, a Hindu female, aged 40, was admitted into the hospital on 12-9-51, for pain and foreign body sensation in both the eves. The complaint was of three years' duration. The patient was well built and was eight months advanced in pregnancy.
On examination the upper lids showed granulations of trachoma. Trachomatous pannus was present in both the eves, and there were fine corneal opacities. In each eye at the limbus were typical bluish-red nodules of deep scleritis. The vision in the right eve was 6; 24, and in the left eve 6:18.
Slit Lamp Examination : Right eve showed superficial corneal opacities with vascularization and pigmentarv deposit on anterior lens capsule in the lower portion. Neither K.P.'s nor anterior chamber flare were noticed. The left eye showed deeper corneal opacities with deep vascularization.
Blood for Kahn's test was taken on three occasions but was reported negative every time.
Blood Urea: 66 mgs., 100 ml.
Uric Acid: 3.8 mgs. / 100 ml.
Urine Examination: Showed no abnormality.
Sputum: No acid fast bacilli seen.
X-Ray of Chest: Nothing abnormal detected.
Mantoux Test: 1 : 1000 intradermal negative.
She was treated locally with calomel insufflations and sulphonamide with atropin ointment. She received subconjunctival penicillin injections 25.000 units daily. Milk injections were given oil alternate days, and bismuth injections were given once a week for four weeks. The cornea did not show am improvement in their haze. On the contrary K.P.s began to appeal - in both the eyes, but the eyes were quiet. A month and a half after admission she delivered a healthy baby and was discharged.
A month later she carne again, lien eyes considerably worse this time. The opacities had increased, iridocyclitis was active, lots of K.P.'s were seen and in each eye the tension was low. The left eve was worse of the two and became progressively worse, and eventually very soft. The right eye quietened down completely.
On 6-4-52 enucleation was done on the left eve, as the eve had become blind, and was still having recurrent attacks of iridocyclitis. At the time of enucleation a small nodule was noticed on tile inferolateral aspect of the globe.
The specimen showed an entire eye-ball which was smaller than a normal eye. There was a globular mass measuring 0.5 cms. in diameter in the region of the optic nerve. A small length of the optic nerve could be trade out and the globular mass was arising front the infero-lateral aspect of the optic nerve. The globular mass appeared to be covered by a fibrous sheath which was continuous with the sclera. The rest of the eye-ball was normal except for a patchy - opacity of the cornea.
Oil bisecting the eye-ball, the tumour mass appeared to be involving three fourth of the diameter of the optic nerve and the mass scented to be extending upto the papilla and in between the retina and the sclera to a length of 0.5 cm. on either side.
The mass was homogeneous grey in appearance and firm to feel. The retina showed detachment in the region of the lateral extension of the tumour mass.
Microsroby The tumour mass was composed of a conglomeration of several typical tubercles and had involved practically the whole thickness of the optic nerve; only a few healthy nerve bundles could be seen at one end. The tubercles -Showed minimum amount of caseation in the centre but the proliferative reaction, with giant cells, epithelioid cells lymphocytes and young fibroblasts, was well marked and very conspicuous. The mass was not extending upto the papilla which was normal and healthy, but the growth appeared to be extending laterally involving the choroid and the sclera.
Along the length of the sclera and in the cornea multiple discreet tubercles of varying sires also could be seen.
The choroid and the iris also showed extensive involvement.
In all these tubercles, discreet or conglomerated, caseation Was very little and the proliferative reaction was well marked.
In the several sections, retina and Papilla were the only two parts of the eve-ball that had escaped involvement by the tubercular process.
It appears from the wide spread involvement of the eye that the infection was blood borne and caused miliarv tubercles in addition to a conglomerate tuberculosis of the optic nerve with typical confluent tubercles involving a part of the optic nerve and the sclera.
The case evidently is one of granulomatous type of iridocyclitis arising front a primary tuberculoma of the optic nerve, and a non-granulomatous iritis in the opposite eve. The unusual aspects of the case lie in the following facts.
(1) No sign of tuberculosis was manifest elsewhere in the body.
(2) Tuberculin reaction was negative.
(3) The iridocvclitis was associated with a low tension front an early date.
(4) There was no proptosis to suggest a retrobulbar tumor.
(5) The delivery made the eve condition progress in the left eve.
(6) Caseation was very little and proliferative reaction was marked.
(7) Retina and papilla were the only two parts that had escaped involvement by the tubercular process.