Spontaneous corneal perforation as the presenting feature of systemic tuberculosis

We describe eight patients presenting with peripheral corneal perforation, in whom coexisting systemic tuberculosis was detected at presentation. Of these patients, seven were in the paediatric age group and one was a female patient aged 40 years. Three cases were bilateral (all in paediatric patients). On examination a paralimbal perforation was present in all eyes measuring 1.5–2.5 mm×3.0–3.5 mm along the orthogonal meridians (figure 1A,B). There were no signs of infectious keratitis. The corneal thickness was normal in the remaining cornea. On systemic examination, five children had enlarged cervical lymph nodes and two had matted nodes. Fine needle aspiration biopsy of the enlarged nodes revealed caseating necrotising granulomatous inflammation suggestive of tuberculosis (figure 2A). All children had a reactive testing (induration >20 mm) with purified protein derivative tuberculin injection (Mantoux test) (figure 2B). Four of the seven children had received BCG vaccine at birth. The x-ray of the upper thoracic …