Presumed tuberculous sclerokeratitis in a young immunocompetent female – A rare case and review of literature

A 26-year-old female presented with pain and redness in the right eye for 2 months, with no relief on treatment. All laboratory investigations were normal, except for a raised erythrocyte sedimentation rate and a strongly positive tuberculin skin test. Slit-lamp examination of the right eye showed a bluish discoloration of the superior sclera, which spanned 2 o’clock hours and was associated with swelling and congestion of deep episcleral vessels inferiorly and nasally, along with corneal stromal involvement. The fundus of both eyes was normal. A presumptive diagnosis of anterior nodular tuberculous sclerokeratitis was made, and anti-tubercular therapy with topical corticosteroids was initiated. After 4 weeks of treatment, there was a significant clinical improvement. This report highlights the challenge of diagnosing variant presentations of ocular tuberculosis, especially in resource-poor nations endemic for this disease. It is also important to rule out infectious and immune-mediated etiologies of scleritis, which can present with a similar clinical profile, and delay diagnosis and treatment outcome.