Tuberculous Conjunctivitis in an Anophthalmic Socket

Abstract

Tuberculous (TB) conjunctivitis was not an uncommon condition before the early 20(th) century but is currently a rare occurrence, especially in the developed countries. We report a 27-year-old Saudi female who underwent enucleation of the right eye at the age of 20 following a penetrating eye injury. She had a history of miliary TB that was treated at the age of 22. She was presented with chronic purulent discharge from her right an anophthalmic socket for 2 months. Cultures for bacteria and fungi were sterile. There was no response to empirical topical antibiotics and steroids. Direct microscopic examination of conjunctival scrapings with the Ziehl-Neelsen staining revealed no microorganisms. Histopathological examination revealed epithelioid granulomas. Polymerase chain reaction was negative for Mycobacterium tuberculosis DNA. TB conjunctivitis was suspected from the history of miliary TB and presence of epithelioid granulomas. The definitive diagnosis was made after prompt resolution of the ocular signs with no recurrence only after systemic anti-TB therapy.

Keywords: Anophthalmic Socket; Anti-tuberculous Therapy; Enucleation; Miliary Tuberculosis; Tuberculous Conjunctivitis.

Figure 1

Histopathologic examination of a sample of tissue: (a) Squamous epithelium with underlying lymphoplasmacytic inflammatory infiltrate (H and E, ×10). (b) Multiple well-formed epithelioid granulomas are present (H and E, ×20). (c) A granuloma with multiple giant cells (H and E, ×20)

Figure 2

Photograph of the anophthalmic socket, after treatment with systemic anti-tuberculous therapy