Year : 1990 | Volume
: 38 | Issue : 4 | Page : 191--192
Tuberculoma of the orbit-A case report
OPS Maurya, R Patel, V Thakur, R Singh
Department of Opthalmology, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221 005, India
Department of Opthalmology, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221 005
A case of orbital tuberculoma presenting with proptosis and gross diminution of vision in a young girl 20 years is reported. The tuberculoma disappeared within 3 months of antitubercular therapy and there was marked improvement in visual acuity. Because of its rarity in the younger age group, the case is being reported.
|How to cite this article:|
Maurya O, Patel R, Thakur V, Singh R. Tuberculoma of the orbit-A case report.Indian J Ophthalmol 1990;38:191-192
|How to cite this URL:|
Maurya O, Patel R, Thakur V, Singh R. Tuberculoma of the orbit-A case report. Indian J Ophthalmol [serial online] 1990 [cited 2020 Dec 3 ];38:191-192
Available from: https://www.ijo.in/text.asp?1990/38/4/191/25499
Tuberculosis is primarily an infection of lymphoid tissue. The bacilli are confined by the lymph follicles of the mucosa or by the regional lymph nodes. If they succeed in passing the lymph follicles and the lymph nodes, they may be carried to the eye through the blood stream. Tuberculoma of the orbit is a rarer manifestation though the incidence of manifest ocular involvement in sanatoria patients averages from 0.1 to 1.5 per cent.
The patient, U.S. a female aged 20 years reported to us with complaints of pain in the left eye associated with watering and diminution of vision for the lest 2 months. However, during the second month, the vision had grossly deteriorated associated with protrusiJn of the left eye. The patient did not give any past his_ory of fever, chronic cough, chest pain, convulsions or trauma, though a loss in weight was noted by the patient. All the members of her family were healthy and nobody suffered from tuberculosis.
The patient was below average weight for her age. She was not anaemic and lymph glands were not palpable. The visual acuity in the left eye was finger-counting at one meter distance and did not improve with pin hole. There was mild axial proptosis of the left eye. Hertel's exophthalmometry reading of the right eye and left eye were 13 mm. and 20 mm. respectively and ocular movements in all gazes were partially restricted [Figure 1]. There was no palpable mass in the orbit but ie palpebral and bulbar conjunctiva of the left eye showed mild passive congestion. The pupil of the left eye showed ill-sustained reaction to light. Examination of the left fundus revealed post-neuritic optic atrophy. The right eye was normal. On general and systemic examination no clinical abnormality was detected. X-ray chest showed no abnormality.
Hematogical investigations were within normal limits except raised E.S.R; X-ray of skull, orbit, paranasal sinuses and chest were normal. Computerised axial tomography revealed a hypodense lesion along the optic nerve extending well up to the optic foramen in the left retrobulbar region [Figure 2]. The Mantoux test using 1 TU of P.P.D. in 0.1 ml showed 15 mm. of induration with a wide erythematous zone after 72 hours. A trial course of antitubercult r therapy along with vit. B1, B6 and B12 injection was administered. After 3 months of follow up the patients became asymptomatic and visual acuity improved 5/60 (Snellen's Chart). The proptosis completely albappeared and repeat CAT scan showed disappearance of the retrobulbar mass [Figure 3]. Antitubercular therapy was continued for another 6 months and subsquent follow up revealed no recurrence [Figure 4].
Tuberculoma of the orbit is a rare manifestation of the disease wherein a chronic granulomatous mass appears in the orbit presumably due to an infection of haematogenous origin. It usually occurs more in females of about 40-50 years of age. However, in our case it appeared in a 20 years female. The patients usually show tuberculous lesions elsewhere such as pleurisy or old pulmonary focl.  Despite our deligent search we could not detect any tubercular lesion elsewhere in the body except that the Mantoux test was moderately positive. E.S.R. raised and patient gave a history of rapid loss of weight.
The disease may be bilaterally symmetrical  but in our case it appeared uniocularly.
|1||Worshy : Oftal. sbon 7.260. 1932.|
|2||Pascheff : Klin. Mbl., Augenheilk. 76. 646. 1926.|