Orbital tuberculosis presenting as proptosis: A case report

Abstract

A 53-year-old male complained of gradual, painless dimness of vision with swelling of the right eye (R/E) for 15 days. Best-corrected visual acuity in R/E: Hand movement, left eye: 6/9, abaxial proptosis, restricted extraocular movements in all directions, conjunctival injection, and high intraocular pressure R/E were noted. Fundus showed pale optic disc R/E and macular exudates in both eyes. The patient was diabetic and on oral hypoglycemic agents with raised erythrocyte sedimentation rate and C-reactive protein; random blood sugar: 152 mg/dL. Magnetic resonance imaging (MRI) showed right-sided orbital abscess involving extraconal compartment extending into the right orbital apex with compression of the right optic nerve. Mantoux test was positive and computed tomography thorax was normal. Histopathology of biopsy from middle turbinate showed granulomatous inflammatory cellular lesion. The patient was started on anti-tubercular therapy. He got relieved of symptoms. Repeat MRI showed reduction in disease process.