Primary Tubercular Osteomyelitis of Lateral Orbital Wall: A Rare Presentation

Primary Tubercular Osteomyelitis of Lateral Orbital Wall: A Rare Presentation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Primary Tubercular Osteomyelitis of Lateral Orbital Wall: A Rare Presentation Vandana Sharma, vikasdeep gupta, harmeet kaur, anuradha raj This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4422653/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 11 Dec, 2025 Read the published version in Journal of Ophthalmic Inflammation and Infection → Version 1 posted 9 You are reading this latest preprint version Abstract Osteomyelitis of facial bones is a very rare presentation. Primary presentation of tubercular osteomyelitis in facial bones is even rarer. We are reporting a case of zygomatic tubercular osteomyelitis presenting in a very innocuous way. Identification of such cases in early stage can help in timely intervention. A 30 years old female presented to Ophthalmology Out Patient Department (OPD) with complain of a mildly painful nodule over left lower eyelid, turning into an ulcer. After appropriate investigation, diagnosis of primary tubercular osteomyelitis of left zygomatic bone was made and patient underwent debridement and anti-tubercular treatment. Patient has healed satisfactorily, with no sinus formation, no residual bony on filtration and good cosmetic results. Early diagnosis and timely management of such cases can avoid extensive involvement of bone, thereby reducing the subsequent morbidity of the patients. Figures Figure 1 Figure 2 Manuscript Tubercular osteomyelitis commonly involves long bones and the spine. However, rarely, it may also involve the midfacial bones. Out of these, involvement of lateral orbital wall with the disease as a primary presentation of tuberculosis is even rarer. 1 Predisposing factors for skull involvement are malnutrition, poor socioeconomic status, and immunosuppression. 2 Frontal and parietal bones are most commonly involved. 3 Case presentation A 30 year old female presented to Ophthalmology OPD with a complaint of mildly painful ulcer over left lower eyelid for the last three days. The ulcer was preceded by a painful non erythematous nodular lesion over the region noticed 15 days earlier which burst spontaneously. Patient did not have any other systemic or ocular complaints. On examination, the ulcer was circular with a diameter of about 6 mm located at the junction of lateral wall and floor of orbit (Fig. 1 a). 4 The skin around the ulcer was adherent to underlying bone and was non tender. No collection was palpable under the lesion and minimal purulent discharge was visible on the floor of the lesion. No lymphadenopathy was present. Patient was started on oral antibiotics empirically as a preliminary diagnosis of chronic osteomyelitis of zygoma with discharging sinus was made. Patient was given standard antibiotic therapy for two weeks. However no improvement was noted. Contrast enhanced Computed Tomography of the face revealed an ill-defined osteolytic lesion of zygomatic bone on left side with associated sinus tract and mildly enhancing soft tissue thickening (Fig. 2 ) and no deep extension of the pathology into infratemporal fossa. Debridement of the diseased bone was done by the department of Oto-rhino-laryngology and Head Neck Surgery (Fig. 1 b, c and d). Blood investigations revealed a slightly elevated erythrocyte sedimentation rate. Histopathological examination found well-formed epithelioid cell granulomas with central caseating necrosis and multinucleated Langhans’ Giant cells. Ziehl Neelsen stain for acid fast bacilli was positive. Diagnosis was revised to tubercular (TB) osteomyelitis of the zygomatic bone. Chest radiograph did not reveal any primary focus. Cartridge Based Nucleic Acid Amplification Test (CBNAAT) was positive. Therefore, the involvement can be considered to be a primary presentation of tuberculosis in this patient. Patient was started on anti-tubercular treatment as per guidelines and the wound has healed without any sinus formation. Discussion Orbital TB has been clinically classified into five categories: classical periostitis, orbital tuberculoma with no bony destruction, orbital TB with evidence of bony destruction (not classified as classical periostitis), orbital TB as a result of spread from paranasal sinuses and dacryoadenitis. 5 This patient suffered from orbital TB with evidence of bony destruction radiologically as well as surgically. Therefore we should keep a high index of suspicion in such cases with atypical presentation especially in endemic areas. Diagnosing tuberculosis in such cases can be challenging as it may be difficult to identify the mycobacteria due to their small number. A new modality of investigation i.e., CBNAAT can be of help in identifying the small number of mycobacteria in tissue as well as fluids. While it a fast and accurate test with results comparable with culture; high cost, need for a stable electricity supply, replenishment of the cartridges every 18 months, and a stable temperature ceiling limit its application to all cases. 4 Treatment essentially constitutes use of anti-tubercular drugs. Patient must be motivated to be compliant with the drug regimen to avoid development of drug resistance and complete cure. Surgical debridement can be done in extensive disease but there are chances of sinus formation which are difficult to get rid of later on. Debridement was done in this case as a preliminary microbiological examination of the pus discharge did not reveal any Acid Fast Bacilli. Declarations Ethics approval and consent to participate: yes Consent for publication: yes Availability of data and material: not applicable Competing interests: none Funding: none Authors' contributions: VS and VG were primary treating surgeons of the case and have prepared the manuscript. HK was the diagnosing radiologist of the case and has revised the manuscript. AS has revised the manuscript. Acknowledgements: none References Singh V, Khatana S, Gupta P, Bhagol A, Narwal A (2013) Tuberculous osteomyelitis of zygoma: an unusual location. Oral Surg Oral Med Oral Pathol Oral Radiol [Internet]. ;116(3):e156–60. https://doi.org/10.1016/j.oooo.2011.12.017 Chakraborti C, Choudhury KP, Das J (2017) Tuberculous Osteomyelitis of Orbit-A Case Report. Nepal J Ophthalmol 9(18):87–90 Raut Abhijit A, Nagar Arpit M, Muzumdar Datta C, Ashish J, Narlawar Ranjeet S, Fattepurkar, Sudhir et al (2004) Imaging features of calvarial tuberculosis: a study of 42 cases. AJNR Am J Neuroradiol 25(3):409–414 Sahana KS, Prabhu AS, Saldanha PR (2018) Usage of Cartridge Based Nucleic Acid Amplification Test (CB-NAAT/GeneXpert) test as diagnostic modality for pediatric tuberculosis; case series from Mangalore, South India. J Clin Tuberc Other Mycobact Dis 11:7–9 Bhattacharya S, Raina UK, Gupta SK, Mishra M, Saini V, Kumar B (2022) Tubercular Osteomyelitis of the Orbit Presenting as Periorbital Cellulitis. J Ophthalmic Vis Res 17(1):146–149 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 11 Dec, 2025 Read the published version in Journal of Ophthalmic Inflammation and Infection → Version 1 posted Editorial decision: Revision requested 05 Jun, 2025 Reviews received at journal 04 Sep, 2024 Reviews received at journal 29 Aug, 2024 Reviewers agreed at journal 27 Aug, 2024 Reviewers agreed at journal 26 Aug, 2024 Reviewers invited by journal 17 Jun, 2024 Submission checks completed at journal 17 May, 2024 Editor assigned by journal 17 May, 2024 First submitted to journal 15 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4422653","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":307130628,"identity":"943a434b-147c-4210-b2ac-98a03b48722c","order_by":0,"name":"Vandana Sharma","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA50lEQVRIiWNgGAWjYDCCA2CSGUQwPvjAwJCAECRCC7PhDFK1sEnzQLXgBXy3D7BJ/NxhLW/OfoBN2rbNLo+fvYHxcAEeLZLnEtgke8+kG+7sSWC2zm1LLpbsOcBweAYeLQZnGJgNeNsOM244kMB4O7eNOXHDjQSGwzwEtBj+bTtsv+H8AwZpy7Z6orQwPgbaAlLJJM0IYeDXIgnSItuWnrzhxgNmw55zxxNn9hxswKuF7wwDw8G3bda2G84nMD74UVad2M/efPgzPi0MDPwfEAxGNhCDsQGvBjTwhxTFo2AUjIJRMFIAAIsfUdpU7xCFAAAAAElFTkSuQmCC","orcid":"","institution":"MS Ophthalmology, AIIMS","correspondingAuthor":true,"prefix":"","firstName":"Vandana","middleName":"","lastName":"Sharma","suffix":""},{"id":307130629,"identity":"f81dc3bd-f641-43e3-910d-07cb9ad5fea6","order_by":1,"name":"vikasdeep gupta","email":"","orcid":"","institution":"AIIMS","correspondingAuthor":false,"prefix":"","firstName":"vikasdeep","middleName":"","lastName":"gupta","suffix":""},{"id":307130633,"identity":"08cec0aa-98a4-4c94-bc4b-db09feef36fd","order_by":2,"name":"harmeet kaur","email":"","orcid":"","institution":"AIIMS","correspondingAuthor":false,"prefix":"","firstName":"harmeet","middleName":"","lastName":"kaur","suffix":""},{"id":307130635,"identity":"4e4afc06-dbe9-4b3d-bcdb-1ea97f20baee","order_by":3,"name":"anuradha raj","email":"","orcid":"","institution":"MS Ophthalmology, AIIMS","correspondingAuthor":false,"prefix":"","firstName":"anuradha","middleName":"","lastName":"raj","suffix":""}],"badges":[],"createdAt":"2024-05-15 05:18:02","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4422653/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4422653/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12348-025-00518-1","type":"published","date":"2025-12-11T15:59:11+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":57626272,"identity":"c38e8886-eb8c-4a75-be06-7b18eae1362e","added_by":"auto","created_at":"2024-06-03 14:03:07","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":88176,"visible":true,"origin":"","legend":"\u003cp\u003efigure 1a showing ulcer with undermined edges and minimal purulent discharge over floor of ulcer. Figure 1 b, c and d showing debridement of involved bone (b), appearance of wound postoperatively on day 3 (c) and on day 7 (d).\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4422653/v1/0fb81c7435c314f1fab413df.jpg"},{"id":57626273,"identity":"4b8461b7-2729-403d-947b-95c20e44f82e","added_by":"auto","created_at":"2024-06-03 14:03:07","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":293588,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eLeft zygoma Osteomyelitis. \u003c/strong\u003e(a) axial NCCT (soft tissue window), (b) axial NCCT (bone window), (c) coronal CECT (soft tissue window) \u0026amp; (d) oblique sagittal VRT images of the face show an ill-defined osteolytic lesion involving left zygomatic bone with associated sinus tract and mildly enhancing soft tissue thickening (green arrows). NCCT: Non-contrast Computed tomography, CECT: Contrast-enhanced Computed tomography, VRT: Volume Rendering Technique.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4422653/v1/fba84861442e796e28c02ed4.png"},{"id":98244002,"identity":"46628903-2458-40b1-8a6f-6035edbd83fa","added_by":"auto","created_at":"2025-12-15 16:12:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":636332,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4422653/v1/174a1847-342b-4eeb-877f-b3c32173899d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Primary Tubercular Osteomyelitis of Lateral Orbital Wall: A Rare Presentation","fulltext":[{"header":"Manuscript","content":"\u003cp\u003eTubercular osteomyelitis commonly involves long bones and the spine. However, rarely, it may also involve the midfacial bones. Out of these, involvement of lateral orbital wall with the disease as a primary presentation of tuberculosis is even rarer.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Predisposing factors for skull involvement are malnutrition, poor socioeconomic status, and immunosuppression.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Frontal and parietal bones are most commonly involved.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 30 year old female presented to Ophthalmology OPD with a complaint of mildly painful ulcer over left lower eyelid for the last three days. The ulcer was preceded by a painful non erythematous nodular lesion over the region noticed 15 days earlier which burst spontaneously. Patient did not have any other systemic or ocular complaints.\u003c/p\u003e \u003cp\u003eOn examination, the ulcer was circular with a diameter of about 6 mm located at the junction of lateral wall and floor of orbit (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003ea). \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e The skin around the ulcer was adherent to underlying bone and was non tender. No collection was palpable under the lesion and minimal purulent discharge was visible on the floor of the lesion. No lymphadenopathy was present. Patient was started on oral antibiotics empirically as a preliminary diagnosis of chronic osteomyelitis of zygoma with discharging sinus was made. Patient was given standard antibiotic therapy for two weeks. However no improvement was noted.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eContrast enhanced Computed Tomography of the face revealed an ill-defined osteolytic lesion of zygomatic bone on left side with associated sinus tract and mildly enhancing soft tissue thickening (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) and no deep extension of the pathology into infratemporal fossa.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eDebridement of the diseased bone was done by the department of Oto-rhino-laryngology and Head Neck Surgery (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eb, c and d). Blood investigations revealed a slightly elevated erythrocyte sedimentation rate. Histopathological examination found well-formed epithelioid cell granulomas with central caseating necrosis and multinucleated Langhans\u0026rsquo; Giant cells. Ziehl Neelsen stain for acid fast bacilli was positive. Diagnosis was revised to tubercular (TB) osteomyelitis of the zygomatic bone. Chest radiograph did not reveal any primary focus. Cartridge Based Nucleic Acid Amplification Test (CBNAAT) was positive. Therefore, the involvement can be considered to be a primary presentation of tuberculosis in this patient.\u003c/p\u003e \u003cp\u003ePatient was started on anti-tubercular treatment as per guidelines and the wound has healed without any sinus formation.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOrbital TB has been clinically classified into five categories: classical periostitis, orbital tuberculoma with no bony destruction, orbital TB with evidence of bony destruction (not classified as classical periostitis), orbital TB as a result of spread from paranasal sinuses and dacryoadenitis.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e This patient suffered from orbital TB with evidence of bony destruction radiologically as well as surgically.\u003c/p\u003e \u003cp\u003eTherefore we should keep a high index of suspicion in such cases with atypical presentation especially in endemic areas. Diagnosing tuberculosis in such cases can be challenging as it may be difficult to identify the mycobacteria due to their small number. A new modality of investigation i.e., CBNAAT can be of help in identifying the small number of mycobacteria in tissue as well as fluids. While it a fast and accurate test with results comparable with culture; high cost, need for a stable electricity supply, replenishment of the cartridges every 18 months, and a stable temperature ceiling limit its application to all cases.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eTreatment essentially constitutes use of anti-tubercular drugs. Patient must be motivated to be compliant with the drug regimen to avoid development of drug resistance and complete cure. Surgical debridement can be done in extensive disease but there are chances of sinus formation which are difficult to get rid of later on. Debridement was done in this case as a preliminary microbiological examination of the pus discharge did not reveal any Acid Fast Bacilli.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate: yes\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsent for publication: yes\u003c/p\u003e\n\u003cp\u003eAvailability of data and material: not applicable\u003c/p\u003e\n\u003cp\u003eCompeting interests: none\u003c/p\u003e\n\u003cp\u003eFunding: none\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions: VS and VG were primary treating surgeons of the case and have prepared the manuscript. HK was the diagnosing radiologist of the case and has revised the manuscript. AS has revised the manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements: none\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSingh V, Khatana S, Gupta P, Bhagol A, Narwal A (2013) Tuberculous osteomyelitis of zygoma: an unusual location. Oral Surg Oral Med Oral Pathol Oral Radiol [Internet]. ;116(3):e156\u0026ndash;60. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.oooo.2011.12.017\u003c/span\u003e\u003cspan address=\"10.1016/j.oooo.2011.12.017\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChakraborti C, Choudhury KP, Das J (2017) Tuberculous Osteomyelitis of Orbit-A Case Report. Nepal J Ophthalmol 9(18):87\u0026ndash;90\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRaut Abhijit A, Nagar Arpit M, Muzumdar Datta C, Ashish J, Narlawar Ranjeet S, Fattepurkar, Sudhir et al (2004) Imaging features of calvarial tuberculosis: a study of 42 cases. AJNR Am J Neuroradiol 25(3):409\u0026ndash;414\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSahana KS, Prabhu AS, Saldanha PR (2018) Usage of Cartridge Based Nucleic Acid Amplification Test (CB-NAAT/GeneXpert) test as diagnostic modality for pediatric tuberculosis; case series from Mangalore, South India. J Clin Tuberc Other Mycobact Dis 11:7\u0026ndash;9\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBhattacharya S, Raina UK, Gupta SK, Mishra M, Saini V, Kumar B (2022) Tubercular Osteomyelitis of the Orbit Presenting as Periorbital Cellulitis. J Ophthalmic Vis Res 17(1):146\u0026ndash;149\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-ophthalmic-inflammation-and-infection","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"joii","sideBox":"Learn more about [Journal of Ophthalmic Inflammation and Infection](http://joii-journal.springeropen.com)","snPcode":"12348","submissionUrl":"https://submission.nature.com/new-submission/12348/3","title":"Journal of Ophthalmic Inflammation and Infection","twitterHandle":"@SpringerOpen","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4422653/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4422653/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eOsteomyelitis of facial bones is a very rare presentation. Primary presentation of tubercular osteomyelitis in facial bones is even rarer. We are reporting a case of zygomatic tubercular osteomyelitis presenting in a very innocuous way. Identification of such cases in early stage can help in timely intervention. A 30 years old female presented to Ophthalmology Out Patient Department (OPD) with complain of a mildly painful nodule over left lower eyelid, turning into an ulcer. After appropriate investigation, diagnosis of primary tubercular osteomyelitis of left zygomatic bone was made and patient underwent debridement and anti-tubercular treatment. Patient has healed satisfactorily, with no sinus formation, no residual bony on filtration and good cosmetic results. Early diagnosis and timely management of such cases can avoid extensive involvement of bone, thereby reducing the subsequent morbidity of the patients.\u003c/p\u003e","manuscriptTitle":"Primary Tubercular Osteomyelitis of Lateral Orbital Wall: A Rare Presentation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-03 14:03:02","doi":"10.21203/rs.3.rs-4422653/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-05T18:09:22+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-04T11:36:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-29T18:07:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"139969193527751786929996186136656718978","date":"2024-08-27T04:53:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"18021491356974853022594739535278827757","date":"2024-08-26T13:51:29+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-17T08:35:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-17T05:16:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-17T05:16:46+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Ophthalmic Inflammation and Infection","date":"2024-05-15T05:16:49+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-ophthalmic-inflammation-and-infection","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"joii","sideBox":"Learn more about [Journal of Ophthalmic Inflammation and Infection](http://joii-journal.springeropen.com)","snPcode":"12348","submissionUrl":"https://submission.nature.com/new-submission/12348/3","title":"Journal of Ophthalmic Inflammation and Infection","twitterHandle":"@SpringerOpen","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f516d6a4-582d-4590-af84-b8348ff14561","owner":[],"postedDate":"June 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-15T16:05:14+00:00","versionOfRecord":{"articleIdentity":"rs-4422653","link":"https://doi.org/10.1186/s12348-025-00518-1","journal":{"identity":"journal-of-ophthalmic-inflammation-and-infection","isVorOnly":false,"title":"Journal of Ophthalmic Inflammation and Infection"},"publishedOn":"2025-12-11 15:59:11","publishedOnDateReadable":"December 11th, 2025"},"versionCreatedAt":"2024-06-03 14:03:02","video":"","vorDoi":"10.1186/s12348-025-00518-1","vorDoiUrl":"https://doi.org/10.1186/s12348-025-00518-1","workflowStages":[]},"version":"v1","identity":"rs-4422653","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4422653","identity":"rs-4422653","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}