Ocular Tuberculosis

Abstract

Ocular tuberculosis is an extrapulmonary mycobacterial infection with variable manifestations. The reported incidence of ocular involvement varies considerably, depending on the criteria used for diagnosis and the population sampled. However, tuberculosis is thought to affect the lungs in 80% of patients, with the remaining 20% being affected in other organs, such as the eye. It is imperative for physicians to consider this diagnosis in their differential, as ocular tuberculosis can present in a fashion similar to that of more common conditions causing ocular inflammation. In addition, prompt recognition of the clinical signs and symptoms leads to quicker initiation of antituberculosis therapy.

Presumed ocular tuberculosis in the United Kingdom: a British Ophthalmological Surveillance Unit (BOSU) study

“…32% had anterior uveitis alone but 40% had panuveitis and 23% had a retinitis or vasculitis. It is well recognised that the uveal tract is involved in the majority of ocular TB cases as it has the greatest blood flow resulting in haematogenous spread [ 23 ]. Our findings concur with the previous studies that have demonstrated that posterior uveitis is the most common presentation [ 24 ].…”

“…Systemic treatment is always warranted as although ocular manifestation may be the presenting complaint, pulmonary or other foci of infection may co-exist and, in some cases, the ophthalmic signs are thought to be an immunological response to a distant focus. Further studies regarding ocular penetration are required but oral Rifampicin has been found to reach aqueous levels of up to 9% which is felt to be therapeutic [ 23 ]. Established ATT treatment regimens have been found to be very effective, with previous studies reporting resolution of uveitis in approximately 60–70% [ 7 ].…”

Tuberculosis presenting as dacryoadenitis in the USA

“…In the USA, ocular TB accounts for only 0.5% of uveitis cases 4. Ocular TB is most often secondary to haematogenous spread and affects the uveal tract of the eye 5. Rarely, ocular TB manifests as extraocular disease in the eyelids and conjunctivae, as well as the cornea, sclera and lacrimal gland 6 7.…”

Posterior uveitis secondary to an African grey parrot bite

“…1 Hematogenous spread of TB to the eye is more likely to occur than a primary exogenous infection and most commonly affects the uvea due to its high vascular content. 2 The diagnosis of ocular TB is often presumptive and based on the presence of characteristic clinical features in conjunction with imaging and laboratory investigations. Although TB is endemic in other countries, it is relatively uncommon in North America and is therefore a less common cause of uveitis.…”

“…6 Particularly, tuberculous uveitis is most commonly seen and may be acquired through direct mycobacterial infection of the eye, hematogenous spread of bacteria, or an immunemediated hypersensitivity reaction from a remote or systemic TB infection. 2 Tuberculous uveitis is a vision-threatening disease, thereby necessitating prompt diagnosis and treatment to reduce morbidity.…”