1
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Khan L. Clinician's approach for spectrum of orbital diseases: An overview. J Family Med Prim Care 2024; 13:851-858. [PMID: 38736778 PMCID: PMC11086771 DOI: 10.4103/jfmpc.jfmpc_761_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/29/2023] [Accepted: 07/01/2023] [Indexed: 05/14/2024] Open
Abstract
Purpose To study the varied clinical presentation and outcome of management of orbital diseases and to ascertain the concordance of FNAC with histopathology. Materials and Methods This is a prospective interventional study wherein each patient's clinical presentation was noted. Outcome of management was evaluated based on symptomatic relief, regression of signs, noting any intraoperative or postsurgical complication, recurrence, and cosmetic result in terms of surgical scar. Results Neoplasia was commonest 33/76; (43.42%), followed by infective and inflammatory conditions 21/76; (27.63% cases), thyroid-associated orbitopathy accounting for 12/76 cases (15.78%), whereas cystic lesions and vascular malformations were 4/76 (5.26%) each. Other disorders constituted a mere 2.65%. Proptosis was the commonest mode of presentation. It was seen in seventy out of seventy-six patients (92.1%). In 86.3% of the cases, there was successful surgical outcome. Of 22 surgically managed cases, recurrence was noted in three cases (13.6%). 90% concordance was seen with histopathology in cases where FNAC was done prior to surgery for diagnosing nature of disease. Conclusions Majority of orbital and adnexal conditions can be provisionally diagnosed based on imaging; however, an adjunct invasive investigation such as FNAC or biopsy may be required. In the present study, in seven cases (9.2%) FNAC was needed, whereas in two cases (2.63%) biopsy was needed. A definitive diagnosis was confirmed by histopathology in 22 surgically managed cases and by excision biopsy in two. 22/76 (28.94%) of the cases needed surgical treatment, and other cases required conservative or palliative approach.
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Affiliation(s)
- Lubna Khan
- Department of Ophthalmology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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2
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Touati M, Ibrahim A, Ousmane KAK, Al-Zekri M, Baaré I, Morsli A. A rare case of orbital tuberculosis with cold abscess and frontal bone lesion. Pan Afr Med J 2020; 37:167. [PMID: 33425200 PMCID: PMC7757277 DOI: 10.11604/pamj.2020.37.167.21298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 07/13/2020] [Indexed: 11/23/2022] Open
Abstract
Tuberculosis is a multisystem infectious disease caused by Mycobacterium tuberculosis and a leading infectious cause of morbidity and mortality worldwide. Orbital tuberculosis is a rare form of extra pulmonary tuberculosis, even in endemic areas. It may involve the soft tissue, lacrymal gland, periosteum, or bones of the orbital wall and can extend to adjacent paranasal sinuses or intracranial cavities. The delay in diagnosis can be due to the fact that the clinical signs simulate any inflammatory disease. The diagnosis is usually based on tissue examination in histopathological evidence presenting as granulomatous lesion or presence of acid fast bacilli (AFB). The long term anti tuberculosis therapy is the effective treatment. Here we present the case of orbital tuberculosis on a young man operated in our department and who had a good outcome under anti tuberculosis drugs for 12 months.
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Affiliation(s)
- Mahdia Touati
- Department of Neurosurgery, CHU Bab El Oued, Algiers, Algeria
| | - Assoumane Ibrahim
- Department of Neurosurgery, CHU Bab El Oued, Algiers, Algeria.,Neurosurgery Department, Maradi Reference Hospital, Maradi, Niger
| | | | - Muneer Al-Zekri
- Department of Neurosurgery, CHU Bab El Oued, Algiers, Algeria
| | - Ibrahim Baaré
- Ophthalmology Department, Maradi Reference Hospital, Maradi, Niger
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3
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Yoon HS, Na YC, Lee HM. Primary orbital tuberculosis on the lower eyelid with cold abscess. Arch Craniofac Surg 2019; 20:274-278. [PMID: 31462022 PMCID: PMC6715547 DOI: 10.7181/acfs.2019.00339] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 08/11/2019] [Indexed: 01/09/2023] Open
Abstract
Orbital tuberculosis is a rare form of extrapulmonary tuberculosis, even in endemic areas. It may involve the soft tissue, lacrimal gland, periosteum, or bones of the orbital wall. We present a case of orbital tuberculosis on the lower eyelid. An 18-year-old woman with no underlying disease visited our clinic for evaluation of an oval nodule (1.5× 1.2 cm) on the right lower eyelid. Incision and drainage without biopsy was performed 2 months ago in ophthalmology department, but the periorbital mass had deteriorated, as the patient had erythematous swelling, tenderness, and cervical lymphadenopathy. Visual acuity was normal; there were no signs of proptosis, diplopia, or ophthalmoplegia. Computed tomography revealed a small abscess cavity without bony involvement. We performed an excision and biopsy through a percutaneous incision under local anesthesia. Histological examination revealed a granuloma and was diagnosed as orbital tuberculosis. The patient was additionally treated with anti-tuberculosis therapy for 6 months and recovered without complication or recurrence by 7 months. Orbital tuberculosis occurs in patients with or without associated pulmonary tuberculosis, and should be considered as a differential diagnosis in patients with inflammatory orbital disease and an orbital mass. If recurrence occurs despite adequate initial treatment, we recommend an additional examination and excisional biopsy.
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Affiliation(s)
- Hyun Sik Yoon
- Department of Plastic and Reconstructive Surgery, Wonkwang University Hospital, Iksan, Korea
| | - Young Cheon Na
- Department of Plastic and Reconstructive Surgery, Wonkwang University Hospital, Iksan, Korea
| | - Hye Mi Lee
- Leehyemi Plastic Surgery Clinic, Gwangju, Korea
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4
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Singh M, Gupta N, Zadeng Z, Singh N, Kaur M, Gupta P. Long-Term Outcomes of Oral Anti-Tubercular Therapy in Patient with Tubercular Dacryoadenitis: A Case Series. Ocul Immunol Inflamm 2018; 27:1016-1022. [PMID: 29958045 DOI: 10.1080/09273948.2018.1486437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: To describe the clinico-radiological features and long-term outcomes in patients with tubercular dacryoadenitis (TbD) Methods: Retrospective, observational study of TbD patients who underwent a thorough clinical examination, orbital imaging study, and tailored ancillary investigations. Polymerase chain reaction (PCR) and microscopy were done in specific cases. A 4-drug anti-tubercular therapy (ATT) was started and clinical response was monitored in all. Patients with a minimum follow-up of 6 months "off-ATT" were included. Results: All patients were women and three presented with pain, blepharoptosis, and bilateral involvement. In all, ESR was raised, Mantoux test was positive and orbital imaging revealed enlarged lacrimal gland/s. Positive PCR and granulomatous inflammation on microscopy were seen in two patients. At a mean follow-up of 17.25 months, all women responded with no relapse or clinical recurrence. Conclusion: Bilateral lacrimal gland enlargement, positive Mantoux & PCR with early response to ATT may provide sufficient evidence for diagnosing TbD.
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Affiliation(s)
- Manpreet Singh
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Nalini Gupta
- Department of Cytology & Gynaecological Pathology, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Zoramthara Zadeng
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Nirbhai Singh
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Manpreet Kaur
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Pankaj Gupta
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
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5
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Hamed-Azzam S, AlHashash I, Briscoe D, Rose GE, Verity DH. Rare Orbital Infections ~ State of the Art ~ Part II. J Ophthalmic Vis Res 2018; 13:183-190. [PMID: 29719648 PMCID: PMC5905313 DOI: 10.4103/jovr.jovr_202_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Infections of the orbit and periorbita are relatively frequent. Identifying unusual organisms is crucial because they can cause severe local and systemic morbidity, despite their rarity. Opportunistic infections of the orbit should be considered mainly in debilitated or immunocompromised patients. The key to successful management includes a high index of suspicion, prompt diagnosis, and addressing the underlying systemic disease. This review summarizes unusual infectious processes of the orbit, including mycobacterial, fungal, and parasitic infections, as well as their pathophysiology, symptoms, signs, and treatment.
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Affiliation(s)
- Shirin Hamed-Azzam
- Orbital Service, Moorfields Eye Hospital, London EC1V 2PD, UK.,St John Ophthalmic Association, London EC1M 6BB, UK
| | | | | | - Geoffrey E Rose
- Orbital Service, Moorfields Eye Hospital, London EC1V 2PD, UK
| | - David H Verity
- Orbital Service, Moorfields Eye Hospital, London EC1V 2PD, UK.,St John Ophthalmic Association, London EC1M 6BB, UK
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6
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Boonsopon S, Tesavibul N, Uiprasertkul M, Leeamornsiri S, Choopong P. Rare presentation of intractable tuberculous panophthalmitis with intraocular and intraorbital abscesses: a case report. J Med Case Rep 2017; 11:180. [PMID: 28673337 PMCID: PMC5496312 DOI: 10.1186/s13256-017-1353-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/31/2017] [Indexed: 11/29/2022] Open
Abstract
Background We report a rare presentation of extrapulmonary tuberculosis. Case presentation A 29-year-old Burmese woman with human immunodeficiency virus infection and known pulmonary tuberculosis who had been treated for 5 months presented to our hospital with unilateral progressive painful visual loss of 1 month’s duration. She was diagnosed with tuberculous panophthalmitis with subretinal and intraorbital abscesses, conjunctival abscess, and extraocular muscle tuberculoma. The diagnosis was confirmed by a conjunctival pus swab with a positive result for acid-fast bacilli and a positive result for a mycobacterial culture. There was high suspicion of multidrug-resistant tuberculosis. Despite receiving ongoing aggressive treatment with conventional antituberculous medications, this patient required subtotal orbital exenteration to control her infection and prevent further progression. Second-line antituberculous medications were added to the first-line therapy, with satisfactory results achieved. Conclusions Tuberculous panophthalmitis with intraocular and intraorbital abscesses is a rare presentation of extrapulmonary tuberculosis. Patients who do not respond to first-line antituberculous therapy might be infected with either single-drug or multidrug-resistant Mycobacterium tuberculosis. Patient compliance is one of the key factors that can alter the course of treatment. Careful patient monitoring can improve disease progression, outcome, and prognosis.
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Affiliation(s)
- Sutasinee Boonsopon
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Nattaporn Tesavibul
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Mongkol Uiprasertkul
- Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supinda Leeamornsiri
- Department of Ophthalmology, Faculty of Medicine, Thammasat Hospital, Thammasat University, Bangkok, Thailand
| | - Pitipol Choopong
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
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7
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Dalvin LA, Smith WM. Orbital and external ocular manifestations of Mycobacterium tuberculosis: A review of the literature. J Clin Tuberc Other Mycobact Dis 2015; 4:50-57. [PMID: 31723688 PMCID: PMC6850259 DOI: 10.1016/j.jctube.2015.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 11/07/2015] [Accepted: 11/16/2015] [Indexed: 11/24/2022] Open
Abstract
Tuberculosis (TB) is an airborne infectious disease caused by Mycobacterium tuberculosis that most commonly affects the lungs. However, extrapulmonary manifestations of TB can affect the eye and surrounding orbital tissues. TB can affect nearly any tissue in the eye, and a high index of suspicion is required for accurate diagnosis. Systemic anti-tuberculosis treatment is required in cases of ocular TB, and steroids are sometimes necessary to prevent tissue damage secondary to inflammation. Delays in diagnosis are common and can result in morbidities such as loss of an affected eye. It is important for ophthalmologists and infectious disease specialists to work together to accurately diagnose and treat ocular TB in order to prevent vision loss. This article reports the various known presentations of orbital and external ocular TB and reviews important elements of diagnosis and treatment.
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Affiliation(s)
- Lauren A Dalvin
- Department of Ophthalmology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Wendy M Smith
- Department of Ophthalmology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
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8
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9
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Farshchi S, Hasibi M, Ashtiani MTK, Yazdani N, Mokhtari Z, Farshchi A. A misdiagnosis led to an extensive skull base surgery: infratemporal tuberculosis mimicking giant cell tumor. Indian J Otolaryngol Head Neck Surg 2014; 65:83-5. [PMID: 24381928 DOI: 10.1007/s12070-012-0591-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 10/29/2012] [Indexed: 12/01/2022] Open
Abstract
Tuberculosis is a major health problem in developing countries. Tuberculosis of the infratemporal region is not common and the diagnosis could be complicated because of the similarity of the presentation to neoplasm. In our paper, we report a 49 year old male presented with a preauricular mass with extension to parotid in right side of the face. The primary histologic diagnosis was giant cell tumor with bony involvement and radical surgery was taken. After 16 months the patient was developed recurrence of the primary lesion in association with post auricular fistula. Ultimately, infratemporal tuberculosis was diagnosed according to result of the drained discharge by AFB microscopy. Therefore, tuberculosis should be considered as an important differential diagnosis of mass lesions in head and neck area, even when there is no history of significant exposure and no systemic signs or symptoms of tuberculosis.
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Affiliation(s)
- Samireh Farshchi
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Amir-A'lam Hospital, North Sa'adi Ave., Tehran, Iran
| | - Mehrdad Hasibi
- Department Of Infectious Diseases, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Nasrin Yazdani
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Amir-A'lam Hospital, North Sa'adi Ave., Tehran, Iran
| | - Zahra Mokhtari
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Amir-A'lam Hospital, North Sa'adi Ave., Tehran, Iran
| | - Amir Farshchi
- Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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10
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Narula MK, Chaudhary V, Baruah D, Kathuria M, Anand R. Pictorial essay: Orbital tuberculosis. Indian J Radiol Imaging 2011; 20:6-10. [PMID: 20351984 PMCID: PMC2844753 DOI: 10.4103/0971-3026.59744] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Tuberculosis of the orbit is rare, even in places where tuberculosis is endemic. The disease may involve soft tissue, the lacrimal gland, or the periosteum or bones of the orbital wall. Intracranial extension, in the form of extradural abscess, and infratemporal fossa extension has been described. This pictorial essay illustrates the imaging findings of nine histopathologically confirmed cases of orbital tuberculosis. All these patients responded to antituberculous treatment.
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Affiliation(s)
- Mahender K Narula
- Department of Radiodiagnosis, Lady Hardinge Medical College and Associated Smt. Sucheta Kriplani and Kalawati Hospitals, New Delhi - 110 001, India
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11
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Abstract
PURPOSE OF REVIEW The purpose of this report is to present an update on the manifestations and management of ocular tuberculosis. RECENT FINDINGS Tuberculosis affects one-third of the world's population. The incidence of tuberculosis has increased with the increase in the HIV infected population. Following a resurgence of the disease in the US, the incidence has recently declined. Patients may develop scleritis that can be focal, nodular or diffuse with or without keratitis. Anterior granulomatous uveitis may occur. The posterior segment reveals vitritis, choroiditis, and can mimic serpiginous choroiditis and other entities. Patients who are immunosuppressed or HIV infected may develop active mycobacterial disease in the eye leading to rapid destruction of the ocular structures. The diagnosis of ocular tuberculosis is made by isolation of Mycobacterium tuberculosis on Löwestein-Jensen medium or by PCR. The diagnosis is supported by the clinical findings, imaging techniques including optical coherence tomography, fluorescein angiography, indocyanine green and ultrasonography. Tuberculin skin test helps to confirm the diagnosis. SUMMARY Ocular tuberculosis may occur in the absence of pulmonary disease. Patients present with a spectrum of clinical signs. The disease may mimic several clinical entities. Early diagnosis and prompt treatment of ocular tuberculosis may prevent ocular morbidity and blindness.
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12
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Madge SN, Prabhakaran VC, Shome D, Kim U, Honavar S, Selva D. Orbital tuberculosis: a review of the literature. Orbit 2008; 27:267-277. [PMID: 18716964 DOI: 10.1080/01676830802225152] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE To provide an up-to-date review of the clinical presentations, investigations, and management of orbital tuberculosis (OTB). METHODS Systematic review of the literature concerning OTB, limiting the results to English-language peer-reviewed journals. RESULTS Seventy-nine patients from 39 publications were identified as cases of OTB. The condition presents in one of five forms: classical periostitis; orbital soft tissue tuberculoma or cold abscess, with no bony involvement; OTB with bony involvement; spread from the paranasal sinuses; and tuberculous dacryoadenitis. The ocular adnexa, including the nasolacrimal system and overlying skin, may also be involved. CONCLUSIONS Diagnosis can be difficult and may necessitate an orbital biopsy, in which acid-fast bacilli (AFB) and characteristic histopathology may be seen. Growth of Mycobacterium tuberculosis (mTB) from such a specimen remains the gold standard for diagnosis. Ancillary investigations include tuberculin skin tests and chest radiography, but more recently alternatives such as whole blood interferon-gamma immunological tests and PCR-based tests of pathological specimens have proven useful. The management of OTB is complex, requiring a stringent public health strategy and high levels of patient adherence, combined with long courses of multiple anti-tuberculous medications. The interaction of the human immunodeficiency virus (HIV) with TB may further complicate management.
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Affiliation(s)
- Simon N Madge
- Oculoplastic & Orbital Division, Discipline of Ophthalmology and Visual Sciences, Level 8, Royal Adelaide Hospital, North Terrace, Adelaide 500, Australia.
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13
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Shome D, Honavar SG, Vemuganti GK, Joseph J. Orbital Tuberculosis Manifesting With Enophthalmos and Causing a Diagnostic Dilemma. Ophthalmic Plast Reconstr Surg 2006; 22:219-21. [PMID: 16714937 DOI: 10.1097/01.iop.0000214528.96858.ad] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 60-year-old woman with no known systemic disease was referred with a hard mass in the left orbit and enophthalmos of two months duration. Differential diagnoses of metastasis from an undetected scirrhous carcinoma and sclerosing nonspecific orbital inflammatory disease were considered and a biopsy was performed. Histopathology demonstrated granulomatous inflammation with fibrosis. Subsequent polymerase chain reaction was positive for Mycobacterium tuberculosis deoxyribonucleic acid. There was no evidence of systemic tuberculosis. The patient was treated with four-drug combination anti-tubercular therapy for 6 months. The mass regressed and there was no local recurrence at two years follow-up. Orbital tuberculosis generally manifests with proptosis or osteomyelitis. However, enophthalmos may be caused by the fibrosing variant. Biopsy with histopathologic and microbioloic evaluation is essential to distinguish it from other more common causes of an orbital mass with paradoxical enophthalmos such as metastatic scirrhous carcinoma and sclerosing nonspecific orbital inflammatory disease.
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Affiliation(s)
- Debraj Shome
- Department of Ophthalmic Plastic Surgery, Orbit and Ocular Oncology, LV Prasad Eye Institute, Hyderabad, India
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14
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Abstract
Ocular scrofuloderma with orbital tuberculosis is a rarely described presentation of childhood tuberculosis. Bilateral involvement has not been reported earlier in the medical literature. Here is reported a 3-year-old boy who presented with bilateral infraorbital swellings of tubercular etiology. Computed tomography (CT) scan of the upper face revealed enhancing soft tissue lesions in both the lower lids of the eyes, with extraconal extension into the orbits and with erosion of the right zygomatic bone. Tubercular etiology was confirmed by the Ziehl Neelsen staining of the aspirate from the lesion, which was positive for acid-fast bacilli and growth of Mycobacterium tuberculosis in the aspirate culture. The patient showed marked improvement of his lesions on anti-tubercular treatment.
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Affiliation(s)
- Suvasini Sharma
- Department of Pediatrics Pathology, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India.
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15
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Dewan T, Sangal K, Premsagar IC, Vashishth S. Orbital tuberculoma extending into the cranium. Ophthalmologica 2006; 220:137-9. [PMID: 16491039 DOI: 10.1159/000090581] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2004] [Accepted: 12/23/2004] [Indexed: 11/19/2022]
Abstract
Orbital tuberculoma is not uncommon in the developing countries, but intracranial extension of orbital tuberculoma is extremely rare. Our case, a 14-year-old girl, presented with proptosis and progressive painless diminution of vision eventually leading to loss of vision. MRI showed a mass with peripheral enhancement of contrast, separate from the optic nerve and extending into the cranium through the optic foramen. Early decompression and chemotherapy resulted in marked visual recovery. Histopathology of the excised lesion confirmed tuberculosis. The case is reported to highlight both the rare presentation as well as remarkable visual recovery in a patient with orbital tuberculosis.
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Affiliation(s)
- Taru Dewan
- Department of Ophthalmology, Dr. Ram Manohar Lohia Hospital, New Delhi, India.
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16
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Mistr S, Chavis PS. Treatment of neuro-ophthalmologic manifestations of tuberculosis. Curr Treat Options Neurol 2005; 8:53-67. [PMID: 16343361 DOI: 10.1007/s11940-996-0024-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In the absence of obvious pulmonary or disseminated tuberculosis, ocular and central nervous system (CNS) tuberculosis may represent a significant diagnostic challenge. Refinements in polymerase chain reaction techniques and neuroimaging have strengthened the battery of tests used to diagnose CNS and ocular tuberculosis, yet in many cases, the diagnosis remains one of exclusion; it may ultimately be determined through exacerbation by anti-inflammatory therapy with subsequent improvement by antitubercular medication treatment. Because of emerging drug resistance, at least a two-drug regimen is required for therapeutic testing and treatment of isolated ocular tuberculosis. If pulmonary or miliary disease coexists, a 6-month, four-drug regimen with isoniazid, rifampin, pyrazinamide, and ethambutol is required for treatment. Tubercular meningitis is treated with the same four-drug regimen for at least 9 to 12 months. Burden of therapeutic compliance rests on the treating physician and public health sector. Best compliance is realized with directly observed therapy.
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Affiliation(s)
- Susannah Mistr
- Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, 167 Ashley Avenue, Charleston, SC 29425, USA
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17
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Affiliation(s)
- Khalid F Tabbara
- The Eye Center and Eye Foundation for Research in Ophthalmology, PO Box 55307, Riyadh 11534, Saudi Arabia
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18
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Dhaliwal U, Arora VK, Singh N, Bhatia A. Clinical and cytopathologic correlation in chronic inflammations of the orbit and ocular adnexa: a review of 55 cases. Orbit 2004; 23:219-25. [PMID: 15590523 DOI: 10.1080/01676830490512260] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Fine-needle aspiration cytology has been used for the diagnosis of neoplastic lesions of the orbit and ocular adnexa with some success. However, inflammatory conditions have not received much attention. This is a retrospective study of fine-needle aspirations of chronic inflammations of the orbit and ocular adnexa over a 15-year period from January 1988 through December 2002. Clinical records and stained smears were reviewed. There were 55 chronic inflammations, presenting as masses, cysts, abscesses, discharging sinuses and dermal plaques and nodules. Forty-two were granulomatous inflammations comprising chalazion (18), tuberculosis (5), Cysticercus cellulosae (3), ruptured epidermal cysts (2), actinomycosis (1) and leprosy (13). Thirteen patients had chronic non-specific inflammations. Fine-needle aspiration cytology is a useful diagnostic procedure in chronic inflammations of the ocular adnexa. Specific diagnosis is possible in many granulomatous inflammations, allowing appropriate, individualized therapy to be initiated.
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Affiliation(s)
- Upreet Dhaliwal
- Department of Ophthalmology, University College of Medical Sciences, Delhi, India
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19
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Yang JW, Kim YD. A Case of Primary Lid Tuberculosis after Upper Lid Blepharoplasty. KOREAN JOURNAL OF OPHTHALMOLOGY 2004; 18:190-5. [PMID: 15635835 DOI: 10.3341/kjo.2004.18.2.190] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Primary lid tuberculosis after lid surgery is a very rare condition and is likely caused by the introduction of bacilli through epithelial injury. Secondary infection, due to direct hematogenous spread or contiguous spread from adjacent structures are more common presentations of lid tuberculosis. The authors experienced a case of primary lid tuberculosis occurring in a 19 year old female after blepharoplasty for making a eyelid crease. Her upper lid skin showed a reddish and non-tender mass lesion measured 3x1 cm, which was diagnosed as the tuberculosis through typical histopathological findings (caseous necrosis), acid-fast bacilli stain and PCR, and treated with anti-tuberculosis medications.
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Affiliation(s)
- Jae Wook Yang
- Department of Ophthalmology, Busan Paik Hospital, In Je University, Busan, Korea
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