Anterior segment mass in miliary tuberculosis: a confusing scenario

Tuberculosis (TB) is one of the most prevalent diseases in the Indian subcontinent. Ocular TB presenting as iris mass is rare; furthermore, invasion of anterior segment without choroidal invasion is even more scarce. Presented here is a case report detailing the condition of a patient in late adolescence who presented with diminution of vision and pain in the left eye. Slit lamp biomicroscopy revealed a nodular vascular mass emerging from the iris. Subsequently, the patient underwent a fine needle aspiration biopsy from the anterior chamber, which yielded a positive result for acid-fast bacilli. The patient was immediately started on an antitubercular treatment (ATT) regimen under steroid cover. Despite the amelioration of symptoms within a month, poor visual gain was noted. However, the intervention prevented the necessity of enucleation. This case underscores the imperative of maintaining a high index of suspicion for ocular tuberculosis in patients exhibiting iris masses, particularly in endemic regions.