Conjunctival tuberculosis: causes, symptoms, diagnosis, treatment

Tuberculosis of the conjunctiva can develop with primary infection of the conjunctiva (exogenous route), the transition of inflammation from the skin of the eyelids and the mucous membrane of the lacrimal sac, hematogenous-lymphogenous metastasis from other organs.

In case of exogenous damage, tuberculous granuloma is promoted by the disruption of the integrity of the mucous membrane. However, cases of tuberculous granuloma of the conjunctiva without damage to this membrane have been described. As a rule, the preauricular lymphatic glands are involved in the inflammatory process. The mucous membrane of the upper eyelid is most often affected, where grayish nodules with a tendency to caseation and ulcer development occur. Clinical signs of inflammation are moderately expressed. The ulcer usually has an irregular shape, can spread to the cartilage and muscle tissue of the eyelid: its bottom is bumpy, with undermined edges and sebaceous exudate.

A long torpid course is typical. In an unfavorable progressive form, destruction of the eyelid with subsequent deformation and development of lagophthalmos is possible. During antibacterial treatment and chemotherapy, such a course is observed extremely rarely. Diagnostics should include bacteriological, cytological examination, biopsy of the affected tissue and parotid lymph nodes. Differential diagnostics should be carried out with an ulcer of syphilitic etiology (hard chancre) and neoplasm (basal cell or squamous cell carcinoma).

Epibulbar tuberculosis. Yellowish-pink nodules appear in the thickness of the conjunctiva and superficial layers of the sclera in the limbus or perilimbal region. In some cases, their surface ulcerates. Such infiltrates are tuberculous granules. In these forms, hematogenous metastasis cannot be ruled out. However, the vascular tract of the eye remains intact. The disease is observed against the background of tuberculous intoxication. It is also possible for Mycobacterium tuberculosis to penetrate into the thickness of the conjunctiva from the vessels of the perilimbal network.