Redness in a Squinted Eye: Is that a Clue?

A 7-year-old boy presented with an acute-onset squint of 10-day duration. His father was diagnosed with pulmonary tuberculosis and was on antitubercular treatment for 2 months. On examination, he had left lateral rectus palsy ([Fig. 1]). His left eye had a pinkish-white nodule on the temporal side of the limbus with congestion ([Fig. 2A]). Rest of his examination were unremarkable. His cerebrospinal fluid showed 19 cells/mm³ (90% lymphocytes), 60 mg/dL sugar, and 59.2 mg/dL protein. Magnetic resonance imaging brain showed a small tuberculoma with perilesional edema in the pons. The tuberculin test was positive (20 mm). Computed tomography chest revealed conglomerate necrotic lymph nodes in right paratracheal, pretracheal, precarinal, hilar, and subcarinal region. A diagnosis of intrathoracic lymphnodal tuberculosis with tubercular meningitis and phlyctenular keratoconjunctivitis was made. On four-drug antitubercular treatment with steroids, a near-complete resolution of the nodule was observed after 4 weeks of treatment ([Fig. 2B, C]).

Fig. 1 Observe the squint due to the left sixth cranial nerve palsy and the mild redness of left eye.

Fig. 2 Observe the elevated pinkish-white nodule on the temporal side of limbus with conjunctival congestion due to phlyctenular keratoconjunctivitis (A), the lesion gradually becomes less prominent with treatment with antitubercular drugs in 4 weeks (B, C).

Phlyctenular keratoconjunctivitis is a nodular inflammation of the cornea or conjunctiva that results from a type-IV cell-mediated hypersensitivity reaction to a foreign antigen. It has been described in association with lymphnodal, cutaneous, sinonasal, pulmonary, and other forms of tuberculosis.[1] [2] The other sensitizing agents include staphylococcal products, fungi, viruses, and parasites.[3] [4]

Author Contributions

A.C. and N.S. wrote the first draft of the manuscript, which was then corrected by all authors.

Publication History

Received: 28 February 2024

Accepted: 19 March 2024

Accepted Manuscript online:
22 March 2024

Article published online:
24 April 2024

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