Management challenge: Optic disc granuloma in pulmonary tuberculosis.

A 45-year-old gentleman presented with chronic cough and defective vision in his right eye. The best-corrected vision was 5/60, and fundus examination revealed optic disc granuloma with surrounding retinal edema [Fig. 1a]. The chest X-ray showed a cavitary lesion in the right upper lobe [Fig. 1b] and sputum culture was positive for tuberculosis. The patient was started on standard 4-drug antitubercular therapy along with oral prednisolone 1 mg/kg in tapering dose in view of his ocular condition. On follow-up, disc granuloma resolved [Fig. 1c and d] and visual acuity improved to 6/18. Ocular damage occurs as the result of infection as well as reactive tissue inflammation. Treatment has to address both arms.[1234]

Figure 1

(a) Ocular fundus photo showing optic nerve head granuloma (arrowhead), peripapillary retinal edema (asterisx), and engorged retinal veins (arrow). (b) Chest X-ray showing cavitary lesion (arrowhead) in the right upper lobe. (c) Resolving optic disc granuloma (arrowhead) and peripheral chorioretinal lesion (arrow) 1-month postantitubercular treatment. (d) Complete resolution of granuloma (arrowhead) with peripheral chorioretinal scarring (arrow) 3-month postantitubercular treatment

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