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Iris Granuloma. Dr Mamta Agarwal Dr J Biswas. History. 44yr / M C/O mild redness, decreased vision & mass in the right eye x 3-4 months No h/o any surgery, trauma. No systemic illness. Clinical findings. BCVA OD - 6/9 OS – 6/6 SLE OD
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Iris Granuloma Dr Mamta Agarwal Dr J Biswas
History • 44yr / M • C/O mild redness, decreased vision & mass in the right eye x 3-4 months • No h/o any surgery, trauma. • No systemic illness
Clinical findings • BCVA OD - 6/9 OS – 6/6 • SLE OD • Aqueous cells & flare 1+ • Mutton fat keratic precipitates • Lobulated, pinkish – white mass with irregular surface extending from 7 – 9 clock hours in the inferotemporal quadrant
Mass in the anterior chamber Mutton Fat KPs Slit lamp photograph OD
Gonioscopy OD
Ultrasound biomicroscopy • Mass lesion involving ciliary body and iris, extending three clock hours in inferotemporal quadrant
Investigations • Laboratory tests • Complete blood count - normal • ESR – 43 mm Ist hr • Serum ACE – 92.2U/L (12-68) • Mantoux test – Negative
Investigations • Chest X ray • Hilar lymphadenopathy & parenchymal lesions suggestive of ‘Sarcoidosis’ • Cervical lymphadenopathy
242 bp Aqueous tap Agarose gel photograph showing the amplified products of Mycobacterium tuberculosis Lane 1 & 2 : Negative Control M. tuberculosis Lane 3: AC tap Positive for M. tuberculosis Lane 4: M. tuberculosis( H37Rv) Positive control DNA
Differential diagnosis • Tuberculosis • Sarcoidosis
Sarcoidosis • CXR Hilar lymphadenopathy • S. ACE High • ESR Raised • Mantoux test negative • Cutaneous anergy
Tuberculosis • Mantoux test Negative • S.ACE High (granulomatous reaction) • ESR Raised • AC Tap PCR Mycobacterium tuberculosis - positive
Treatment • Anti Tubercular therapy • Systemic & topical steroids
After 5 months OD Complete resolution of the granuloma
Other options of treatment…… • ? Treated with ATT alone • ? Treated as Sarcoid only • ? Biopsy from the lesion itself • ? Excision biopsy
Conclusion • TB & sarcoidosis can present as granuloma of the iris. • Polymerase chain reaction of the intraocular fluids can help in the diagnosis.