Ocular tuberculosis: an update

Abstract

Tuberculosis (TB) is an infectious disease responsible for significant morbidity and mortality worldwide. It is a resurgent disease in the developed world. The World Health Organization estimates that one third of the world's population is currently infected, with 9 million new cases occurring annually, leading to 3 million deaths per year (WHO Report, 2007). The disease affects the ocular anterior segment, the posterior segment, and adnexa. The purpose of this review is to describe the ocular manifestations, diagnosis and treatment of tuberculosis and to emphasize the fact that ocular tuberculosis may occur in the absence of systemic clinical activity and may mimic several clinical entities. Various studies have shown a clinical significance of purified protein derivative test results and computerized tomography of the chest while, molecular diagnostic procedures have provided a new approach to establishing the diagnosis of ocular tuberculosis. The current review focuses on the diagnostic modalities, various clinical features, and treatments for management of intraocular tuberculosis recommended in recent publications. It is an update on the manifestations and management of ocular tuberculosis.

An Update on Tubercular Uveitis

“…In severe cases, a subretinal abscess may rupture into the vitreous and result in endophthalmitis or panophthalmitis [36,37]. Panophthalmitis with scleral involvement may occur leading to globe rupture or scleral calcification in advanced cases [4,38].…”

“…In contrast to classic serpiginous choroiditis, the lesions in TB-associated serpiginous-like choroiditis are more pigmented, more likely to be multifocal, and often arise outside the peripapillary region [32]. Any choroiditis lesion has the potential to breach the Bruch's membrane and hence must be monitored for the development of choroidal neovascularization [4]. There may be retinal vasculitis with perivascular choroidal lesions.…”

“…MTb being an obligate aerobe affects organs in the body with high oxygen tension such as the lungs, kidneys, bone, meninges and choroid in the eye [4,16]. The uveal tract in the eye has a high blood supply making it the commonest ocular site for TB [16].…”

“…Optic neuropathy may also occur due to a hypersensitivity response to the tubercular antigen [4]. The various manifestations of involvement of the optic nerve may be papillitis, papilledema, optic neuritis, retrobulbar neuritis and optic nerve tubercles [39][40][41].…”

“…An increasing trend of extrapulmonary tuberculosis was seen from 16% in 1992 to 21% in 2002 of all reported cases of tuberculosis to the CDC (Table 1) [3]. The incidence of ocular TB ranges from 1.45% to 5.74% [4]. TB is no longer limited to under-developed nations and people from lower socioeconomic groups.…”