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A Rare Case of Tubercular Scleral Abscess

Isha Acharya, MBBS, Jolly Rohatgi, MBBS, MS, and Ashit Handa, MBBS

(Asia Pac J Ophthalmol (Phila) 2021;10:596) the inferior quadrant. Intraocular pressure was 16 mm Hg. Ultra-
sound B-scan showed a hypoechoic lesion in the inferior sclera.

A 65-year-old male presented with pain and redness of left eye

for 1.5 months following history of contact with a vegetative
foreign body for which he was putting frequent topical steroids
Suspecting foreign body granuloma, topical steroids were
stopped and fortified antibiotic drops were started with cycloplegic.
Chest X-ray with Mantoux test revealed pulmonary Kochs
and antibiotics but without any resolution. for which Antitubercular treatment was started. The patient got
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On left eye examination, best-corrected visual acuity was 6/
24 with projection of rays accurate. The scleral abscess was noted
inferonasal with diffuse conjunctival congestion (Fig. 1). Anterior
chamber depth was normal with 2þ cells and pigments at the back
of the cornea and the anterior lens capsule. The pupil was
sluggishly reacting with festooned pupil on dilatation. On poste-
rior segment examination, media was clear with normal disc and
macula although multiple small choroidal tubercles were seen in
symptomatically better on antibiotic drops although significant
improvement occurred after starting Antitubercular treatment
(Fig. 2).
This case demonstrates a rare presentation of intraocular
tuberculosis with an incidence of around 7% to 8%.1 It is
important to differentiate noninfectious2 from infectious scleritis,
and tubercular scleritis is an important differential in endemic
countries like India.

FIGURE 1. Clinical presentation on day 1 showing scleral abscess

FIGURE 2. Clinical presentation on day 15 showing area of resolving
(yellow arrow) inferiorly with diffuse conjunctival congestion.
scleral abscess (white arrow) with bluish discoloration of sclera
inferiorly (blue arrow) suggestive of scleral thinning.

Submitted June 12, 2021; accepted June 23, 2021.

From the Department of Ophthalmology, University College of Medical Sciences
(UCMS), Guru Teg Bahadur (GTB) Hospital, Delhi, India.
REFERENCES
The authors have no conflicts of interest to declare. 1. Jabs DA, Mudun A, Dunn JP, et al. Episcleritis and scleritis: clinical
Address correspondence and reprint requests to: Isha Acharya, Department of
Ophthalmology, UCMS and GTB Hospital, Delhi, Dilshad Garden, Delhi features and treatment results. Am J Ophthalmol. 2000;130:469–476.
110095, India. E-mail: isha515acharya@gmail.com
Copyright ß 2021 Asia-Pacific Academy of Ophthalmology. Published by Wolters 2. Biswas J, Dutta Majumder P, Agrawal R, et al. Current approach for the
Kluwer Health, Inc. on behalf of the Asia-Pacific Academy of Ophthalmology. diagnosis and management of noninfective scleritis. Asia Pac J Ophthalmol
This is an open access article distributed under the terms of the Creative
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ISSN: 2162-0989
DOI: 10.1097/APO.0000000000000423

596 | https://journals.lww.com/apjoo ß 2021 Asia-Pacific Academy of Ophthalmology.