Tubercular Scleritis, A Case Report And Review Of Literature

1. Ranjana Sharma¹
2. Sanjay Marasini¹
3. Bhagawat Prasad Nepal¹

¹Kathmandu University Hospital, Dhulikhel, Nepal

Purpose
Tuberculosis remains the world's leading infectious cause of death and causes a variety of diseases throughout the body and eye. The demographics of infection vary widely, with developing countries bearing the heaviest burden of disease and incidence is increasing in developed country due to increase HIV infection. Scleritis is a severe painful inflammatory process centered in the sclera. We describe a case of unilateral nodular non-necrotizing anterior scleritis of tubercular origin.

Case detail
A 30-year-old lady presented with severe uniocular pain, redness, blurring of vision, lacrimation and photophobia of her left eye since 26 days. On examination sectorial conjunctival congestion in nasal side from 7-9oclock position with circum-corneal congestion was present. There was a 6mm x 8 mm yellowish single nodule on infero-nasal quadrant at 8 o'clock position with overlying and surrounding edema. She was diagnosed with anterior nodular non necrotizing scleritis and was treated with topical steroids. No signs of improvement were observed initially and subsequent clinical and laboratory investigation confirmed the diagnosis of left eye ocular tuberculosis.

Result
Good response with the treatment with anti -tubercular therapy was seen, as the nodule started resolving within three weeks.

Conclusion
Anterior nodular non-necrotizing scleritis is relatively an uncommon presentation of ocular tuberculosis. It may be difficult to diagnose and manage the disease as there is no definitive protocol for management. However good history, detail clinical evaluation, appropriate and timely management shows a good response to the disease.