M. Gopal Kishan1, Sheetal Baldava2, Syed Musaab Mohiuddin3
Interstitial Keratitis is non-ulcerating inflammation of the corneal stroma without the involvement of either epithelium or endothelium.(1) Keratitis in scleritis is either infiltrative or destructive. Infiltrative lesions present as localised or diffuse stromal keratitis, sclerosing keratitis or as deep keratitis. Sclerosing keratitis is known to be associated with rheumatoid arthritis,(2) onchocerciasis, tuberculosis(3) and other infective or auto immune diseases. We are reporting a case of sclerosing keratitis in a patient with reactivated tuberculosis. A 40 year old female patient presented with unilateral sclerosing keratitis and mild anterior uveitis with recent loss of weight and easy fatigability. She revealed a history of pulmonary tuberculosis in the past, for which she received Anti Tubercular Therapy for 6 months and was then declared cured at the time. A thorough workup for systemic risk factors was performed to evaluate etiological factors responsible for the keratitis and uveitis with special emphasis on tuberculosis. Though the blood work and radiology reports did not allow a definitive diagnosis of tuberculosis, in view of her past history, a therapeutic trial was initiated by restarting ATT. This resulted in improvement in her general condition. Though the corneal opacities didn’t resolve, there was an arrest in their progression. Over the next 8 months, the corneal lesions remained stable. An ocular event was the only obvious sign in this patient to indicate reactivation of systemic tuberculosis and it helped initiate treatment emphasizing the role of an ophthalmologist in early detection and prompt institution of treatment in systemic diseases.