Abstract
IntroductionTransient myopia has been reported to occur in a number of conditions, either ocular in origin or associated with an underlying systemic cause. We present a rare case of this abnormality occurring in the setting of systemic tuberculosis.Case presentationA 29-year-old Indian woman presented with sudden onset blurred distance vision and fever. Examination revealed visual acuity of counting fingers in both eyes improving to 6/9 with pinhole with N5 reading acuity. Anterior segment examination revealed narrow angles on gonioscopy. Posterior segments were normal. Systemic examination revealed a fluctuant mass in her left loin, aspiration of which yielded pus which was culture-positive for Mycobacterium tuberculosis. The Mantoux test elicited a strongly positive reaction. Chest X-ray and magnetic resonance imaging of the brain were unremarkable. Computed tomography scan and magnetic resonance imaging of the spine and abdomen revealed a large psoas abscess communicating with the loin mass. Two vertebrae were involved but not the spinal cord or canal.ConclusionTransient myopia is a rare presenting feature of systemic tuberculosis. A postulated mechanism in this patient is that development of a uveal effusion related to systemic tuberculosis caused anterior rotation of the iris-lens diaphragm, thereby inducing narrowing of the angle and acute myopia.
Highlights
Transient myopia has been reported to occur in a number of conditions, either ocular in origin or associated with an underlying systemic cause
A postulated mechanism in this patient is that development of a uveal effusion related to systemic tuberculosis caused anterior rotation of the iris-lens diaphragm, thereby inducing narrowing of the angle and acute myopia
Transient myopia has been reported as a clinical feature related to a number of causes, including connective tissue disease [1], pharmacological effect [2], or following trauma [3]
Summary
This patient's ocular features were suggestive of acute, transient myopia. The postulated mechanism is that a ciliary body effusion, not evident on clinical examination, resulted in forward rotation of the iris-lens diaphragm, causing shallowing of the anterior chamber and a lensinduced myopic shift. Uveal effusion with induced myopia has been reported in the setting of HIV, whereby such an effusion – for which the authors were unable to explain the pathophysiology – confirmed on B-scan ultrasonography, precipitated anterior rotation of the iris-lens diaphragm precipitating angle closure glaucoma [4] This case was successfully managed using topical steroids, aqueous suppressants and mydriatics. Vitritis Papillitis, optic or retrobulbar neuritis Localised or multifocal choroiditis, chorioretinitis Retinal vasculitis Orbital granuloma http://www.jmedicalcasereports.com/content/2/1/350 aetiologic and pathophysiological mechanisms in this individual are unknown, we presume the presence of uveal effusion related to the underlying condition This case report demonstrates the need to consider a systemic cause in a febrile patient presenting with acute myopia and angle closure. A copy of the written consent is available for review by the Editor-in-Chief of this journal
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
