Medical Ophthalmology: Case ten


Figure 1

Figure 2

This Asian man recently developed a chesty cough and pain in both eyes and the pre-tibial regions.

a. What do the picture shows?

Figure 1 shows bilateral temporal conjunctival redness caused by phlyctenulosis. It results from immune response to sensitized antigens such as tuberculin antigen. In the UK, it is most commonly associated with Staphylococcus aureus. The condition is usually bilateral.
Figure 2 shows erythema nodosum. This is caused by subcutaneous inflammation which is vasuclitic in origin. It is associated with tuberculosis, streptococcus infection, rheumatic fever and drugs (such as sulphonamides and penicillin).
b. What is the most likely underlying condition?

c. What other ocular lesion can occur with this condition?

Ocular features of tuberculosis include:

Anterior segment:

  • lupus vulgaris on the eyelids
  • phlyctenulosis
  • scleritis
  • granulomatous panuveitis
Posterior segment:
  • chorioretinal granuloma
  • exudative retinal detachment
  • ocular palsies from cranial nerve palsies (in TB meningitis)
  • optic neuropathy secondary to ethambutol therapy

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