Orbital Dirofilariasis

in this case, oral prednisolone was required. In other case series, high dose oral prednisolone (1 mg/kg) was effective and tapered off over 12 weeks in a paradoxical reaction with TB lymphadenitis presented with tense swelling and pus in tissue [1]. As seen in our case, steroid therapy should be considered for extensive tissue damage due to paradoxical reaction. Although eyelid TB is very rare, TB infection should be considered in cases of atypical cellulitis or severe granulation on eyelid. In addition, if patients respond inadequately or symptoms worsen while on anti-TB therapy, it is very important to consider a paradoxical response and start steroid treatment at an early stage to prevent permanent tissue damage. Of course, other potential causes such as inappropriate anti-TB regimen, incorrect diagnosis, drug resistance, and atypical mycobacterium need to be distinguished.