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Eye Lesion and Tuberculosis

Question:
Indrani Mondal, Nishit Anand, Pooja Mishra, Santosh Kumar
Department of Pediatrics, Mata Gujari Memorial (MGM) Medical College and Lions Seva Kendra Hospital (LSKH), Kishanganj, Bihar, India.

Address for Correspondence: Dr Santosh Kumar, F-110, New Doctors Hostel, MGM campus, Kishanganj, Bihar, India. Email: santoshaiims08@gmail.com

A six year old female presented with photophobia with increased lacrimation in the left eye for 1 month without any constitutional symptoms. Ophthalmologic examination revealed marked circumcorneal congestion and a single greyish white nodular lesion with a leash of blood vessels extending to the limbus in the left eye (figure 1). There was marked blepharospasm, photophobia and excessive lacrimation. Visual acuity was normal in both eyes. On general examination, she had mild pallor and right sided non matted cervical lymphadenopathy measuring 3 ×2 cm. Systemic examination was normal. Hemogram, liver and kidney function tests and stool examination were within normal limits. Mantoux test (1 TU unit) was 19 mm after 48 hours. Bacterial culture from lid margin and conjunctiva were sterile. Fine needle aspiration cytology from the cervical lymph node showed epitheloid granuloma and acid fast bacilli on Ziehl-Neelsen staining but no growth on culture. The child was started on anti-tubercular therapy. Topical steroid and antibiotic eye drops were prescribed. There was complete resolution of eye lesions with residual corneal micro opacities.

Figure 1: Greyish white nodular lesion along upper limbal region in left eye

What is the eye lesion?