Painful proptosis and compressive optic neuropathy in an 11-year-old girl with tuberculosis

Abstract

An 11-year-old girl presented with sudden onset of unilateral proptosis and periocular pain. Initial examination revealed proptosis, restricted vertical ocular motility with vertical binocular diplopia, decreased visual acuity and visual field impairment in the left eye. Systemic work-up revealed extrapulmonary tuberculosis with an inflammatory lesion at the left orbital apex causing a compressive optic neuropathy (CON). Three months after treatment with anti-tuberculosis (TB) therapy the proptosis regressed, the ocular motility normalized, and the central visual acuity recovered. The optic atrophy persisted with partial loss of the visual field. This is a very rare presentation of tuberculosis in an 11-year-old child.