A Rare Case of Tubercular Scleral Abscess.

A 65-year-old male presented with pain and redness of left eye for 1.5 months following history of contact with a vegetative foreign body for which he was putting frequent topical steroids and antibiotics but without any resolution.

On left eye examination, best-corrected visual acuity was 6/24 with projection of rays accurate. The scleral abscess was noted inferonasal with diffuse conjunctival congestion (Fig. 1). Anterior chamber depth was normal with 2+ cells and pigments at the back of the cornea and the anterior lens capsule. The pupil was sluggishly reacting with festooned pupil on dilatation. On posterior segment examination, media was clear with normal disc and macula although multiple small choroidal tubercles were seen in the inferior quadrant. Intraocular pressure was 16 mm Hg. Ultrasound B-scan showed a hypoechoic lesion in the inferior sclera.

FIGURE 1

Clinical presentation on day 1 showing scleral abscess (yellow arrow) inferiorly with diffuse conjunctival congestion.

Suspecting foreign body granuloma, topical steroids were stopped and fortified antibiotic drops were started with cycloplegic.

Chest X-ray with Mantoux test revealed pulmonary Kochs for which Antitubercular treatment was started. The patient got symptomatically better on antibiotic drops although significant improvement occurred after starting Antitubercular treatment (Fig. 2).

FIGURE 2

Clinical presentation on day 15 showing area of resolving scleral abscess (white arrow) with bluish discoloration of sclera inferiorly (blue arrow) suggestive of scleral thinning.

This case demonstrates a rare presentation of intraocular tuberculosis with an incidence of around 7% to 8%.[1] It is important to differentiate noninfectious[2] from infectious scleritis, and tubercular scleritis is an important differential in endemic countries like India.