Case report of tuberculous panophthalmitis

Although tuberculosis is very common in the Indian sub-continent, tuberculous panophthalmitis has not been reported from this region so far. We report a case of a young girl with tuberculous panophthalmitis.

A 12-year-old female child presented with painless progressive loss of vision in the right eye of two months' duration. Examination revealed diffuse corneal haze with deep vascularization, iris nodules, and scleral necrosis. Histopathological examination of the enucleated eye revealed necrotizing granulomatous inflammation, multiple epitheloid cell granulomas, and Langhan's giant cells, along with large areas of caseous necrosis. Chest X-ray revealed right hilar lymphadenopathy with right lower zone infiltration and a small pleural effusion. Considering the clinical picture, histopathology and chest findings, a diagnosis of disseminated tuberculosis was made, and standard four-drug anti tubercular treatment was started. At 2 months follow up there was radiological resolution of the lung lesions and pleural effusion.

Clinical features suggestive of tubercular panophthalmitis are absence of pain, presence of nodules on or within the eyeball, and spontaneous perforation. We would like to emphasize that in all susceptible individuals presenting with clinical suspicion of ocular tuberculosis it would be prudent to start early anti-tubercular therapy to prevent progression to panophthalmitis. A complete systemic workup to look for any other possible focus of tubercular involvement must be done.