Although it most commonly occurs in endemic areas of the developing world, tuberculosis may occur in the developed world as well, most often in individuals with HIV infection or in association with inner-city poverty. Orbital tuberculosis usually results after hematogenous spread from an often-subclinical pulmonary focus, but it may also arise from adjacent tuberculous sinusitis. Patients may present with proptosis, motility dysfunction, bone destruction, and chronic draining fistulas. Most orbital cases are unilateral and occur in children, in whom the infection may masquerade as an orbital malignancy. Pathologic specimens may not reveal acid-fast bacilli, but usually show caseating necrosis, epithelioid cells, and Langerhans giant cells. Skin testing and fine-needle aspiration biopsy with culture performed early in the course of the disease may help establish the diagnosis. Antituberculous therapy is usually curative.
Nontuberculous (atypical) mycobacteria may also infect the periocular tissues. Predisposing factors include immunosuppression, nasolacrimal duct obstruction, trauma, and a history of recent periocular surgery. Postoperative infections occur most commonly after lacrimal surgery but can occur after blepharoplasty as well (Fig 4-4). The causative organisms, which are identified in less than one-third of reported cases, are typically Mycobacterium chelonae or Mycobacterium fortuitum. Treatment consists of periocular debridement and systemic antituberculous antibiotics.
Figure 4-4A patient presents with delayed infection of the left upper eyelid by nontuberculous (atypical) mycobacteria after blepharoplasty.
(Courtesy of Bobby S. Korn, MD, PhD.)
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Mauriello JA Jr; Atypical Mycobacterial Study Group. Atypical mycobacterial infection of the periocular region after periocular and facial surgery. Ophthalmic Plast Reconstr Surg. 2003;19(3):182–188.
Moorthy RS, Valluri S, Rao NA. Nontuberculous mycobacterial ocular and adnexal infections. Surv Ophthalmol. 2012;57(3):202–235.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.