A 7-year-old boy presented with an acute-onset squint of 10-day duration. His father was diagnosed with pulmonary tuberculosis and was on antitubercular treatment for 2 months. On examination, he had left lateral rectus palsy ([Fig. 1]). His left eye had a pinkish-white nodule on the temporal side of the limbus with congestion ([Fig. 2A]). Rest of his examination were unremarkable. His cerebrospinal fluid showed 19 cells/mm3 (90% lymphocytes), 60 mg/dL sugar, and 59.2 mg/dL protein. Magnetic resonance imaging brain showed a small tuberculoma with perilesional edema in the pons. The tuberculin test was positive (20 mm). Computed tomography chest revealed conglomerate necrotic lymph nodes in right paratracheal, pretracheal, precarinal, hilar, and subcarinal region. A diagnosis of intrathoracic lymphnodal tuberculosis with tubercular meningitis and phlyctenular keratoconjunctivitis was made. On four-drug antitubercular treatment with steroids, a near-complete resolution of the nodule was observed after 4 weeks of treatment ([Fig. 2B, C]).

Phlyctenular keratoconjunctivitis is a nodular inflammation of the cornea or conjunctiva that results from a type-IV cell-mediated hypersensitivity reaction to a foreign antigen. It has been described in association with lymphnodal, cutaneous, sinonasal, pulmonary, and other forms of tuberculosis.[1] [2] The other sensitizing agents include staphylococcal products, fungi, viruses, and parasites.[3] [4]