Intraocular Tuberculosis
Mamta Agarwal
Senior Consultant
Uveitis & Cornea Services
Sankara Nethralaya
Chennai
Ocular history
 32 yr/ M
 OD - C/O blurred vision x 4 months
General History
 H/O fever, loss of hearing, weight & appetite since 2
months
 Diagnosed as Tubercular Meningitis
 Current Treatment
 Oral antitubercular therapy
Clinical Presentation
BCVA
OD – CF1m
OS – 6/6
SLE
OD – AC quiet, vit cells+
OS - normal
First Examination - Fundus
OD
OS
Choroidal granuloma with
exudative retinal detachment
Healed choroidal granuloma
HRCT chest
MRI brain
Miliary tuberculosis
Management
 Investigations
 ESR – 60 mm I hr
 HRCT chest – S/O miliary Tuberculosis
 MRI brain –Multiple tuberculoma in brain
parenchyma
 U/S
 Retinochoroidal elevation with exudative RD
 Treatment Oral steroid & Antitubercular therapy
Follow up 2 months
 BCVA
 OD – CF1m
 OS – 6/6
Final Diagnosis
Tubercular Choroidal granuloma
Ocular Tuberculosis
 Extra pulmonary tuberculosis – Pleura, lymphnodes, liver, kidney, CNS, eyes.
 Mechanism of disease
 Hematogenous spread
 Hypersensitivity reaction with distant focus of infection
 Most common clinical manifestations
 Choroidal mass
34%
 Choroiditis/ chorioretinitis
27%
 Vitritis
24%
 Iridocyclitis
13%
 Panuveitis
11%
 Others – conjunctivitis, interstitial keratitis, scleritis, ocular adnexa & orbit
involvement
Discussion
 Diagnosis of ocular TB is a diagnostic challenge.
 Definite diagnosis – PCR/ Culture
 Presumed Ocular Tuberculosis
 Clinical history & findings
 Ancillary tests
 Therapeutic trial of anti tuberculosis treatment
 No single, safe, sensitive, specific test exists.
 Diagnostic tests like aqueous paracentesis or vitreous tap
have lower sensitivities & risk of complications.
Conclusion
 HRCT chest is more sensitive & specific than X rays.
 Mantoux test has limited sensitivity.
 False positive in patients with non tuberculous mycobacterial
infection & post BCG vaccination.
 False negative in immunocompromised states.
 Quantiferon tests fails to distinguish between active & latent infection.
Useful in immunocompromised states, smear negative pulmonary TB.
 PCR tests – Highly specific, low sensitive, invasive procedure.