Tuberculous scleritis: causes, symptoms, diagnosis, treatment

In tuberculosis of the eye, scleritis occurs mainly secondarily due to the spread of the tuberculous process from the vascular tract to the sclera in the area of the ciliary body or peripheral parts of the choroid. Against the background of moderate injection in the sclera, a purple-violet node (infiltrate) appears, accompanied by signs of iridocyclitis or chorioretinitis, less often panuveitis.

Scleritis occurs with frequent relapses and tends to result in the appearance of new nodes, after which thinning of the sclera and the development of staphylomas are observed.

Scleritis is divided into groups depending on the depth of the lesion. The superficial inflammatory process - episcleritis - predominates in tuberculosis-allergic firms. Deep scleritis is observed in hematogenous tuberculosis and, according to the morphology of the structure, refers to granulomatous processes. The structural features of the sclera determine the peculiarity of the course of the inflammatory process: exudative and proliferative reactions are weakly expressed and occur chronically. Reparative processes are carried out mainly due to the vascular-rich neighboring tissues - the connective tissue, episclera, vascular membrane of the eyeball.

Deep tuberculous scleritis is accompanied by the appearance of a deep injection with a violet tint. Depending on the severity of the lesion, one or more infiltrates occur. The cornea may be involved in the process, keratoscleritis develops. With combined lesions of the iris, ciliary body, sclera, cornea, kerato-oclerouveitis occurs. In this case, a plastic process is expressed with the presence of posterior synechiae, adhesion and overgrowth of the pupil, increased intraocular pressure.

In mild cases of the disease (mainly episcleritis and superficial scleritis), the scleral infiltrate is absorbed. In severe cases with massive infiltration, necrosis of cellular elements and scleral plates is observed, and subsequently - replacement with scar tissue, thinning and ectasia of the sclera.

Diagnosis of scleritis is carried out using focal tests, as with other localizations of metastatic tuberculosis of the eye.

Superficial inflammation of the sclera - episcleritis - often develops near the limbus in a limited area where episcleral and conjunctival swelling appears. Subjective complaints (photophobia, lacrimation, pain) are weakly expressed. The course of the disease is torpid with relapses. The extrascleral node resolves and appears in a new place, gradually migrating around the limbus (migrating episcleritis). Tuberculous episcleritis is an allergic reaction to sensitization of the sclera with tuberculin in an active ocular or extraocular lesion.

Treatment of tuberculous scleritis and episcleritis is carried out with specific anti-tuberculosis drugs.