Tuberculous scleritis: causes, symptoms, diagnosis, treatment

With eye tuberculosis, sclerites occur mainly secondary because of the spread of the tuberculosis process from the vascular tract to the sclera in the ciliary region or peripheral parts of the choroid. Against the background of a moderate injection in the sclera, there is a purple-violet node (infiltrate), accompanied by signs of iridocyclitis or chorioretinitis, less often panoveitis.

Sclerites occur with frequent relapses and tend to the appearance of all new nodes, after which there are thinning of the sclera and development of staphylomas.

Sclerites are divided into groups, depending on the depth of the lesion. Superficial inflammatory process - episcleritis - prevails in tuberculosis-allergic firms. Deep scleritis is observed with hematogenous tuberculosis and morphology of the structure refers to granulomatous processes. Features of the structure of the sclera determine the peculiarity of the inflammatory process: exudative and proliferative reactions are weakly expressed and proceed chronically. Reparative processes are carried out mainly at the expense of neighboring tissues rich in blood vessels - the connective membrane, the epicleras, the vascular membrane of the eyeball.

Deep tuberculosis scleritis is accompanied by a deep injection with a violet hue. Depending on the severity of the lesion, one or more infiltrates occur. The process can involve the cornea, keratoscleritis develops. With combined lesions of the iris, ciliary body, sclera, cornea, keratoclerovirus appears. At the same time, a plastic process is expressed with the presence of posterior synechia, adhesion and invasion of the pupil, increased intraocular pressure.

With an easy course of the disease (mainly episcleritis and superficial sclerites), the scleral infiltrate resolves. In a severe process with massive infiltration, necrosis of cellular elements and scleral plates is observed, and subsequently - and replacement with scar tissue, thinning and ectasia of the sclera.

Diagnosis of sclerites is carried out with the help of focal samples, as well as with other locations of metastatic eye tuberculosis.

Superficial inflammation of the sclera - episcleritis - often develops near the limbus in a restricted area, where there is an episcleral and conjunctival swelling. Subjective complaints (photophobia, lacrimation, pain) are poorly expressed. The course of the disease is torpid with relapses. The extrascleral node resolves and arises in a new place, gradually migrating around the limbus (migrating episcleritis). Tuberculosis episcleritis is an allergic reaction to the sensitization of the sclera with tuberculin in an active eye or out-of-focus focus.

Treatment of tuberculous sclerites and episcleritis is carried out by specific antituberculous drugs.