Delhi Journal of Ophthalmology

Looking Beyond the Usual

Jyoti Shakrawal1Rebika Dhiman1Priyanka Prasad1Zainab Vora1Sanjay Sharma1Rohit Saxena1Satya Karna2
1Dr. Rajendra Prasad Centre for Ophthalmic Science, AIIMS, New Delhi, India
2Karna Eye Clinic, Noida, Uttar Pradesh, India

Editor-in-Chief, Delhi Journal of Ophthalmology, Dr R.P.Centre, AIIMS.


Corresponding Author:

Rebika Dhiman (MD)
Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
Email id: drrebika@gmail.com


Received: 04-NOV-2019 Accepted: 21-MAY-2020 Published Online: 21-JUN-2020
DOI: https://dx.doi.org/10.7869/djo.555

Abstract
Vision loss is a common association in tuberculosis. It may be due to direct damage to optic nerves and chaisma by the basal exudates and inflammation, tuberculomas affecting the visual pathway, optochiasmatic arachnoiditis, or papilloedema due to raised intracranial pressure. It may also be the result of toxic effects of anti-tubercular drugs like ethambutol or paradoxical response to ATT leading to expansion or development of new tuberculomas. The diagnosis is often challenging. In this case 13 year old child presented with vision loss in the left eye 2 months after starting the therapy. There was bilateral disc pallor that pointed towards ethambutol toxicity. But perimetry revealed bitemporal hemianopia and a subsequent neuroimaging showed optochiasmatic tuberculoma. Therefore, a proper neuro-ophthalmological work up supplemented with radiological examination can help arrive at a correct diagnosis and guide the appropriate management.

Keywords :Tuberculosis, vision loss, tuberculoma, optochismatic tuberculoma