1/37. Presumed periorbital lupus vulgaris with ocular extension.OBJECTIVE: To report an unusual case of lupus vulgaris that spread to the left anterior ocular surface. DESIGN: Case report. PARTICIPANT: An 18-year-old woman presented with an 8-month history of an infiltrative skin lesion affecting the left lower eyelid and cheek area, left globe, right lacrimal sac area, together with a cystic lesion in the foot area. TESTING/INTERVENTION: The authors describe the clinical findings, radiologic study, and histopathologic study of the conjunctiva, skin, liver, and ankle lesion. The patient was treated with antituberculous medications for 3 months. MAIN OUTCOME MEASURES: Healing of the skin, conjunctival, and bone lesions. RESULTS: The lesion of the face healed, leaving scar tissue. The left eye showed symblepharon with loss of its anterior surface features. The right eye showed no symblepharon, the bones of the foot healed with no deformity, and the liver function test results normalized after 3 months of antituberculous medications. CONCLUSION: lupus vulgaris can be associated with multiple system involvement. Its clinical presentation and behavior depend on the patient's immunity and duration of the disease. early diagnosis and appropriate management may cure the disease with no life-threatening sequelae.- - - - - - - - - - ranking = 1keywords = ocular (Clic here for more details about this article) |
2/37. Ocular manifestations of tuberculosis.OBJECTIVE: To present the clinical and histopathologic findings in five cases of tuberculosis (TB) with various ocular manifestations. DESIGN: Observational case series. methods: Retrospective review of clinical findings, course, and treatment of five patients. Diagnostic techniques, including biomicroscopic, histopathologic, and molecular biologic test results, are presented. MAIN OUTCOME MEASURES: visual acuity, slit-lamp biomicroscopy, indirect ophthalmoscopy, and fluorescein angiography results. RESULTS: The ocular manifestations of TB in our patients included panophthalmitis, endophthalmitis, posterior uveitis with choroidal tubercles, keratitis, and a lid mass. mycobacterium tuberculosis was identified in four cases in ocular specimens using acid-fast bacilli microscopy and in three cases by culture. Rapid diagnosis using polymerase chain reaction was obtained in one case. Extraocular foci of TB were identified in three cases with an intraocular infection at presentation. No patients had the human immunodeficiency virus (hiv) and none were immunocompromised. Two eyes could not be saved using antituberculous treatment because of delayed diagnosis and treatment. CONCLUSIONS: In this age of the hiv pandemic, TB is becoming more common. Because it is curable, heightened awareness and better understanding of the disease's ocular manifestations should be of concern to all ophthalmologists.- - - - - - - - - - ranking = 1.2keywords = ocular (Clic here for more details about this article) |
3/37. Ocular scrofuloderma with unilateral proptosis.Proptosis due to an extraconal orbital abscess of tubercular origin with lacrimal gland involvement, representing ocular scrofuloderma, is a rare entity. This association has not been reported earlier in the literature. We describe a 7-year-old boy who presented with nodulo-ulcerative lesions of tubercular etiology with discharging sinuses on right side of the face and a similar lesion on the right lower eyelid along with proptosis of 4 months duration. Computerized tomography (CT) scan of the head confirmed the extraconal, intraorbital, hyperdense, homogeneously enhancing mass separated from the lateral rectus muscle and further revealed involvement of lacrimal gland along with erosion of the temporal bone. The patient showed marked improvement of his dermatological and ophthalmological lesions with anti-tubercular treatment. Subsequent ultrasound examinations of the orbit revealed regression in the size of the abscess from 10.7 mm to 5.0 mm and then complete disappearance of the abscess obviating surgical intervention.- - - - - - - - - - ranking = 0.2keywords = ocular (Clic here for more details about this article) |
4/37. chorioretinitis induced by intravesical bacillus Calmette-Guerin (BCG) instillations for urinary bladder carcinoma.BACKGROUND: We report the rare case of a chorioretinitis occurring after intravesical BCG instillation to cure in situ carcinoma. history AND SIGNS: A 57-year-old man was treated for bladder carcinoma with BCG instillations. Visual acuity was 20/20 in the right eye and 20/40 in the left eye. Bilateral chorioretinitis was discovered three months after initiation of intravesical BCG therapy. THERAPY AND OUTCOME: No progression of ocular lesions could be seen after a 6 months therapy with rifampicin, isoniazide and ethambutol. CONCLUSIONS: BCG chorioretinitis is a rare complication that can be seen after intravesical BCG therapy. BCG is a live attenuated strain of mycobacterium bovis. Two mechanisms can be proposed as the origin of ocular inflammation: a local immune response or a direct choroidal mycobacterial infection.- - - - - - - - - - ranking = 0.4keywords = ocular (Clic here for more details about this article) |
5/37. subretinal fluid analysis in the diagnosis of choroidal tuberculosis.BACKGROUND: Diagnosis of intraocular tuberculosis is often difficult. A choroidal granulomalike lesion suspected to be the result of tuberculosis could be of other inflammatory, infective, or neoplastic causes. We report two cases in which a choroidal granuloma with exudative retinal detachment was diagnosed as tuberculosis by the detection of acid-fast bacilli in subretinal fluid. methods: Interventional case series. RESULTS: Two female patients had choroidal granulomas with surrounding exudative retinal detachment. Detailed laboratory investigations were unhelpful in diagnosis, and the patients' conditions worsened with systemic steroid therapy. subretinal fluid was tapped and revealed acid-fast bacilli and grew mycobacterium tuberculosis on culture. CONCLUSION: subretinal fluid analysis can help in the detection of tuberculous granuloma and facilitate successful management.- - - - - - - - - - ranking = 0.2keywords = ocular (Clic here for more details about this article) |
6/37. Ocular tuberculosis masquerading as ocular tumors.Tuberculosis has re-emerged as a serious public health problem in recent years. The ocular manifestations of tuberculosis are uncommon and diverse. Occasionally, patients initially present with ocular symptoms that simulate intraocular malignancy or other inflammatory conditions. We present five patients with ocular tuberculosis who were referred with the suspicion of ocular malignancy. Four of the five patients had recently emigrated to the united states. The presenting features of these patients were panophthalmitis (one patient), endophthalmitis leading to scleral perforation (one patient), active choroidal granuloma associated with uveitis (two patients), and amelanotic choroidal lesion without inflammatory signs (one patient). Of these five cases, two had a known history of systemic tuberculosis, while the ocular findings in the other three cases were the presenting manifestation of systemic tuberculosis. Multi-drug antituberculous regimen were employed in all cases for a mean of 9 months (median 6 months, range 6-12 months). Three patients responded well to therapy with salvage of the globe and the two remaining patients underwent primary enucleation for blind painful eye or perforated eye. In conclusion, ocular tuberculosis can have variable clinical manifestations and occasionally appears as an intraocular or epibulbar tumor. A high degree of clinical suspicion is important, especially in immigrants from developing countries.- - - - - - - - - - ranking = 2.4keywords = ocular (Clic here for more details about this article) |
7/37. Tuberculous keratoconjunctivitis.A 15-year-old West Indian boy had a left keratoconjunctivitis (KC) initially thought to be allergic in origin. He then developed a facial vesicular skin rash and a diagnosis of herpes simplex was suspected. Viral cultures were negative and there was a poor response to topical antiviral treatment. The KC progressed and became bilateral causing considerable reduction in the visual acuities. He complained of general fatigue and was pyrexial with generalised non-tender lymphadenopathy. There was a shadow in the upper lobe of the right lung. The bronchus was semioccluded by a non-caseating granuloma but no acid fast bacilli were found in the sputum or bronchial washings. In the presence of a strongly positive Heaf test, anti-tuberculous treatment was instituted which led to rapid resolution of all the systemic and ocular signs.- - - - - - - - - - ranking = 0.2keywords = ocular (Clic here for more details about this article) |
8/37. Orbital tuberculosis diagnosed by immunohistochemistry: case reports.PURPOSE: To describe three cases of orbital tuberculosis, with their clinical characteristics and respective diagnostic procedures, showing the importance of histopathology for the correct diagnosis. patients AND methods: Three patients diagnosed and treated for orbital tuberculosis, in the "Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo" during the years of 1999 and 2001. RESULTS: All of the patients were female and referred a chronic evolution of swelling of one eyelid associated or not with other symptoms. They had not hiv infection. Two of them had positive epidemiology for tuberculosis. However, the search for systemic evidence of the disease and staining for bacilli (Ziehl-Neelsen method) were negative in all three patients. In all the cases, only the biopsy with immunohistochemical analysis could confirm the diagnosis. COMMENTS: Orbital involvement is a rare ocular manifestation of tuberculosis. Even in a tertiary hospital, few cases, if any, are diagnosed per year. However, the global incidence and prevalence of M. tuberculosis infections is not under control yet, and it has been a serious public health problem. Thus, one must be aware of the possibility of tuberculosis among the orbital diseases.- - - - - - - - - - ranking = 0.2keywords = ocular (Clic here for more details about this article) |
9/37. indocyanine green angiography in ocular tuberculosis.PURPOSE: To assess indocyanine green (ICG) angiography as a method for evaluating the extent of choroidal involvement and to compare ICG angiography with fundus fluorescein angiography (FFA) in ocular tuberculosis. methods: FFA and ICG angiography were performed on two patients who had ocular tuberculosis findings during fundus examination. The patients were given topical dexamethasone phosphate, topical cyclopentolate, and oral prednisolone acetate in addition to systemic antimicrobial therapy. Both examinations were repeated after treatment. RESULTS: In one patient, two hypofluorescent lesions that corresponded to the choroidal tuberculomas were noted with ICG angiography. Only one lesion was found during ophthalmoscopic examination and FFA. After treatment, these lesions persisted, but became less hypofluorescent. In the other patient, ICG angiography showed a hypofluorescent choroidal lesion corresponding to the choroidal tuberculoma that was larger than its appearance on FFA. This lesion remained hypofluorescent in all phases of ICG angiography and became less hypofluorescent after treatment. CONCLUSIONS: ICG angiography is a useful method to determine the extent of the choroidal lesion and the stage of disease and to evaluate treatment results in tuberculosis patients.- - - - - - - - - - ranking = 1.2keywords = ocular (Clic here for more details about this article) |
10/37. macular edema as the only ocular finding of tuberculosis.PURPOSE: To describe an infrequent presentation of ocular tuberculosis. DESIGN: Retrospective observational case report. methods: A 61-year-old woman presented with decreased vision in her right eye and cystoid macular edema resistant to periocular corticosteroid treatment. There were no other findings. RESULTS: Diagnosis of probable underlying tuberculosis uveitis with macular edema as the only ocular manifestation was established based on a clinical history of possible tuberculosis during her infancy. Additionally, there were residual findings in the patient's chest x-ray, a positive Mantoux reaction, and mycobacterium tuberculosis in sputum. Specific treatment was implemented for nine months. Cystoid macular edema resolved completely, visual acuity improved (20/20), and no remission occurred during two years of follow-up. CONCLUSIONS: In cases of idiopathic cystoid macular edema, tuberculosis should be considered as a potential cause. When treated, both are curable.- - - - - - - - - - ranking = 1.4keywords = ocular (Clic here for more details about this article) |
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