A rare presentation of eyelid tuberculosis

Mycobacterium tuberculosis is transmitted through aerosolization, hence commonly infects the lungs. The occurrence of extrapulmonary tuberculosis is rare. We report a case of eyelid tuberculosis in a 45-year-old gentleman with a history of treated testicular tuberculosis three years ago. He had insidious onset of painless swelling in the right upper eyelid associated with erythema for one month. He did not have other constitutional symptoms. Initially, he was treated as chalazion and given topical antibiotics. However, the swelling worsened despite medication. His best corrected visual acuity was 6/9 in both eyes. Examination showed an elevated ulcerative growth with broad base which bled easily upon touch. The clinical presentation varies from an eyelid infection as an eyelid tumour can be a diagnostic challenge. A slow response to oral and topical antibiotic warrants an excision biopsy. The results showed chronic granulomatous infection in acid-fast bacilli. An antituberculosis (anti-TB) therapy was started and the patient showed a positive clinical response. Althrough rare, tuberculosis of eyelid should be considered as differential diagnosis of chalazion. Any suspicious case should be confirmed by biopsy followed by anti-TB if indicated.