DR. RICHA NYODU

DR. SAMENDRA KARKHUR, DR. NIKITA YADAV, DR. BHAVANA SHARMA

Abstract

Tubercular vasculitis is an important morphological sub-set, among various forms of tubercular uveitis. It may typically present with hemorrhagic occlusive vasculitis with perivascular choroiditis and infiltration. Associated papillitis, chorioretinitis and vitritis is often present. A 22 year old presented with sudden diminution of vision in RE with VA 6/60 and ill sustained pupillary reaction, 1+ cells and faint flare on fundus examination revealed snowballs with RE peripapillary subhyaloid hemorrhage and BE perivascular infiltrates. PPD was positive. Patient was started on ATT 4 drug regime and 4 doses of IVMP 1g. VA improved to 6/9 in RE after therapy. Retinal hemorrhages are a frequent association with Tubercular Retinal Vasculitis, however peripapillary dense subhyaloid bleeds have rarely been reported. These probably result from rupture of fine papillary vessels. Prompt diagnosis with aggressive steroid therapy and ATT form the mainstay of management.