Nanophthalmos, a congenital rare condition, is defined as a small eye characterized by hypermetropia, narrow anterior chamber, and thickened choroid and sclera. These features create an environment with high risk of developing angle-closure glaucoma (AGC) and higher risk of intraoperative and postoperative complications. This is a case of young female patient with nanophthalmos, chronic angle closure, elevated intraocular pressure (IOP) refractory to medical therapy, iridotomy, and iridoplasty, yet without glaucomatous changes. In a case of nanophthalmos refractive to medical treatment, it is challenging to decide whether lowering IOP and preventing ACG are worth the risk of vision reduction by intraocular lens miscalculation or surgical complications.

We describe the case of a 71-year-old woman with periocular tuberculosis manifesting as eyelid edema. The diagnosis of tuberculosis infection was particularly difficult given the atypical presentation, the negative result of interferon-gamma release assay, and the absence of active or past pulmonary disease. Skin biopsy and its analysis with polymerase chain reaction (PCR) enabled the definitive diagnosis of Mycobacterium tuberculosis infection. This represents an exceptionally rare form of eyelid tuberculosis and highlights the importance of a thorough investigation in the diagnostic workup of unspecified and refractory cases of eyelid edema that should include histopathological tissue analysis.