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Tuberculous Optic Neuropathy

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Ocular Tuberculosis

Part of the book series: Essentials in Ophthalmology ((ESSENTIALS))

Abstract

Tuberculosis is an infection caused by the bacterium Mycobacterium tuberculosis and is most commonly acquired by the inhalational route by which the infectious agent enters into the lungs and the primary infection is established. These infected individuals run a 10% risk of reactivation of the infection which can manifest as either pulmonary or extrapulmonary disease. The hematogenous or lymphatic spread can result in involvement of the other sites. Ocular involvement is reported in 6.8% of patients with pulmonary tuberculosis. Till date, very less has been reported in the literature about the optic nerve involvement in tuberculosis. However, the advent of antimicrobial agents against Mycobacterium tuberculosis has led to marked improvement in the patient survival, and the reports of tuberculous optic neuropathy in the literature have been on rise since then. Tuberculous optic neuropathy entails a host of optic nerve involvements which may follow direct infection with the Mycobacterium tuberculosis, bacille Calmette-Guerin vaccination, or as a result of the hypersensitivity reaction. This bewildering array of manifestations of tuberculous optic neuropathy comprises of optic neuritis, retrobulbar neuritis, papillitis, neuroretinitis, papilledema, and optic nerve tubercle. In this chapter, we try to describe the various types of tuberculous optic nerve involvement, clinical features, diagnostic and treatment modalities, and visual outcomes in these patients.

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References

  1. Gupta A, Sharma A, Bansal R, Sharma K. Classification of intraocular tuberculosis. Ocul Immunol Inflamm. 2015;23(1):7–13.

    Article  PubMed  Google Scholar 

  2. Lara LP, Ocampo Jr V. Prevalence of presumed ocular tuberculosis among pulmonary tuberculosis patients in a tertiary hospital in the Philippines. J Ophthalmic Inflamm Infect. 2013;3(1):1.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Davis EJ, Rathinam SR, Okada AA, Tow SL, Petrushkin H, Graham EM, et al. Clinical spectrum of tuberculous optic neuropathy. J Ophthalmic Inflamm Infect. 2012;2(4):183–9.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Mansour AM. Optic disk tubercle. J Neuroophthalmol Off J N Am Neuroophthalmol Soc. 1998;18(3):201–3.

    CAS  Google Scholar 

  5. Mansour AM, Tabbara KF, Tabbarah Z. Isolated optic disc tuberculosis. Case Rep Ophthalmol. 2015;6(3):317–20.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Hughes EH, Petrushkin H, Sibtain NA, Stanford MR, Plant GT, Graham EM. Tuberculous orbital apex syndromes. Br J Ophthalmol. 2008;92(11):1511–7.

    Article  CAS  PubMed  Google Scholar 

  7. Aupy J, Vital A, Rougier MB, Gradel A, Meissner W, Marchal C, et al. Presumed tuberculous retrobulbar optic neuritis: a diagnosis challenge. J Neurol. 2015;262(2):481–4.

    Article  PubMed  Google Scholar 

  8. Invernizzi A, Franzetti F, Viola F, Meroni L, Staurenghi G. Optic nerve head tubercular granuloma successfully treated with anti-VEGF intravitreal injections in addition to systemic therapy. Eur J Ophthalmol. 2015;25(3):270–2.

    Article  PubMed  Google Scholar 

  9. Padhi TR, Basu S, Das T, Samal B. Optic disc tuberculoma in a patient with miliary tuberculosis. Ocul Immunol Inflamm. 2011;19(1):67–8.

    Article  PubMed  Google Scholar 

  10. Stechschulte SU, Kim RY, Cunningham Jr ET. Tuberculous neuroretinitis. J Neuroophthalmol Off J N Am Neuroophthalmol Soc. 1999;19(3):201–4.

    CAS  Google Scholar 

  11. Monteiro ML, Coppeto JR. Cryptic disseminated tuberculosis presenting as gaze palsy. J Clin Neuroophthalmol. 1985;5(1):27–9.

    Article  CAS  PubMed  Google Scholar 

  12. Saxena R, Menon V, Sinha A, Sharma P, Kumar DA, Sethi H. Pontine tuberculoma presenting with horizontal gaze palsy. J Neuroophthalmol Off J N Am Neuroophthalmol Soc. 2006;26(4):276–8.

    Article  Google Scholar 

  13. Enani M, Al-Nakhli DJ, Bakhsh E. Isolated brain stem tuberculoma presenting with one and a half syndrome. Saudi Med J. 2006;27(9):1407–11.

    PubMed  Google Scholar 

  14. Lolly P, Rachita S, Satyasundar M. Ophthalmic manifestations of central nervous system tuberculosis – two case reports. Indian J Tuberc. 2011;58(4):196–8.

    PubMed  Google Scholar 

  15. Gautam P, Sharma N. Isolated pontine tuberculoma presenting as horizontal gaze palsy. Indian Pediatr. 2015;52(2):166.

    Article  PubMed  Google Scholar 

  16. Agu CC, Aina O, Basunia M, Bhattarai B, Oke V, Schmidt MF, et al. Right gaze palsy and hoarseness: a rare presentation of mediastinal tuberculosis with an isolated prepontine cistern tuberculoma. Case Rep Infect Dis. 2015;2015:718289.

    PubMed  PubMed Central  Google Scholar 

  17. Alvarez GG, Roth VR, Hodge W. Ocular tuberculosis: diagnostic and treatment challenges. Int J Infect Dis. 2009;13(4):432–5.

    Article  PubMed  Google Scholar 

  18. Vasconcelos-Santos DV, Zierhut M, Rao NA. Strengths and weaknesses of diagnostic tools for tuberculous uveitis. Ocul Immunol Inflamm. 2009;17(5):351–5.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Wroblewski KJ, Hidayat AA, Neafie RC, Rao NA, Zapor M. Ocular tuberculosis: a clinicopathologic and molecular study. Ophthalmology. 2011;118(4):772–7.

    Article  PubMed  Google Scholar 

  20. Arora SK, Gupta V, Gupta A, Bambery P, Kapoor GS, Sehgal S. Diagnostic efficacy of polymerase chain reaction in granulomatous uveitis. Tuber Lung Dis Off J Int Union Tuberc Lung Dis. 1999;79(4):229–33.

    Article  CAS  Google Scholar 

  21. Ortega-Larrocea G, Bobadilla-del-Valle M, Ponce-de-Leon A, Sifuentes-Osornio J. Nested polymerase chain reaction for Mycobacterium tuberculosis DNA detection in aqueous and vitreous of patients with uveitis. Arch Med Res. 2003;34(2):116–9.

    Article  CAS  PubMed  Google Scholar 

  22. Shetty SB, Biswas J, Murali S. Real-time and nested polymerase chain reaction in the diagnosis of multifocal serpiginoid choroiditis caused by Mycobacterium tuberculosis – a case report. J Ophthalmic Inflamm Infect. 2014;4(1):29.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Babu K, Bhat SS, Philips M, Subbakrishna DK. Review of results of QuantiFERON TB gold test in presumed ocular tuberculosis in a South Indian patient population. Ocul Immunol Inflamm. 2016;24(5):498–502.

    Google Scholar 

  24. Gupta V, Gupta A, Rao NA. Intraocular tuberculosis – an update. Surv Ophthalmol. 2007;52(6):561–87.

    Article  PubMed  Google Scholar 

  25. Urzua CA, Liberman P, Abuauad S, Sabat P, Castiglione E, Beltran-Videla MA, et al. Evaluation of the accuracy of T-SPOT.TB for the diagnosis of ocular tuberculosis in a BCG-vaccinated, non-endemic population. Ocul Immunol Inflamm. 2016;4:1–5.

    Google Scholar 

  26. Mazurek GH, Jereb J, Vernon A, LoBue P, Goldberg S, Castro K, et al. Updated guidelines for using interferon gamma release assays to detect Mycobacterium tuberculosis infection – United States, 2010. MMWR Recomm Rep Morb Mortal Wkly Rep Recomm Rep Ctr Dis Control. 2010;59(RR-5):1–25.

    Google Scholar 

  27. Ang M, Vasconcelos-Santos DV, Sharma K, Accorinti M, Sharma A, Gupta A, et al. Diagnosis of ocular tuberculosis. Ocul Immunol Inflamm. 2016;5:1–9.

    Google Scholar 

  28. Agrawal R, Gupta B, Gonzalez-Lopez JJ, Rahman F, Phatak S, Triantafyllopoulou I, et al. The role of anti-tubercular therapy in patients with presumed ocular tuberculosis. Ocul Immunol Inflamm. 2015;23(1):40–6.

    Article  CAS  PubMed  Google Scholar 

  29. Lou SM, Montgomery PA, Larkin KL, Winthrop K, Zierhut M, Rosenbaum JT, et al. Diagnosis and treatment for ocular tuberculosis among uveitis specialists: the international perspective. Ocul Immunol Inflamm. 2015;23(1):32–9.

    Article  PubMed  Google Scholar 

  30. Kee AR, Gonzalez-Lopez JJ, Al-Hity A, Gupta B, Lee CS, Gunasekeran DV, et al. Antitubercular therapy for intraocular tuberculosis: a systematic review and meta-analysis. Surv Ophthalmol. 2016;61(5):628–53.

    Article  PubMed  Google Scholar 

  31. Cutrufello NJ, Karakousis PC, Fishler J, Albini TA. Intraocular tuberculosis. Ocul Immunol Inflamm. 2010;18(4):281–91.

    Article  CAS  PubMed  Google Scholar 

  32. Ezer N, Benedetti A, Darvish-Zargar M, Menzies D. Incidence of ethambutol-related visual impairment during treatment of active tuberculosis. Int J Tuberc Lung Dis Off J Int Union Tuberc Lung Dis. 2013;17(4):447–55.

    CAS  Google Scholar 

  33. Chen L, Liang Y. [Optic nerve neuropathy by ethambutol toxicity]. Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chin J Tuberc Respir Dis. 1999;22(5):302–4.

    Google Scholar 

  34. Talbert Estlin KA, Sadun AA. Risk factors for ethambutol optic toxicity. Int Ophthalmol. 2010;30(1):63–72.

    Article  PubMed  Google Scholar 

  35. Rodriguez-Marco NA, Solanas-Alava S, Ascaso FJ, Martinez-Martinez L, Rubio-Obanos MT, Andonegui-Navarro J. Severe and reversible optic neuropathy by ethambutol and isoniazid. Anales del sistema sanitario de Navarra. 2014;37(2):287–91.

    Google Scholar 

  36. Sharma P, Sharma R. Toxic optic neuropathy. Indian J Ophthalmol. 2011;59(2):137–41.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Gumus A, Oner V. Follow up of retinal nerve fiber layer thickness with optic coherence tomography in patients receiving anti-tubercular treatment may reveal early optic neuropathy. Cutan Ocul Toxicol. 2015;34(3):212–6.

    Article  CAS  PubMed  Google Scholar 

  38. Menon V, Jain D, Saxena R, Sood R. Prospective evaluation of visual function for early detection of ethambutol toxicity. Br J Ophthalmol. 2009;93(9):1251–4.

    Article  CAS  PubMed  Google Scholar 

  39. Laktaoui A, Naoumi A, Reda K, Kriet M, Elouarsani A, Khayati A, et al. Macular tuberculoma and optic neuritis: rare association with tuberculosis meningoencephalitis. J Francais D’ophtalmologie. 2009;32(9):673–8.

    Article  CAS  Google Scholar 

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Compliance with Ethical Requirements

Rohit Saxena and Divya Singh declare that they have no conflict of interest. No human or animal studies were carried out by the authors for this chapter.

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Authors and Affiliations

  1. Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Department of Ophthalmology, New Delhi, 110029, India

    Rohit Saxena MD, PhD & Divya Singh MBBS, MD, DNB

Authors
  1. Rohit Saxena MD, PhD
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  2. Divya Singh MBBS, MD, DNB
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Corresponding author

Correspondence to Rohit Saxena MD, PhD .

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Editors and Affiliations

  1. Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

    Atul Kumar

  2. Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

    Rohan Chawla

  3. Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

    Namrata Sharma

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Saxena, R., Singh, D. (2017). Tuberculous Optic Neuropathy. In: Kumar, A., Chawla, R., Sharma, N. (eds) Ocular Tuberculosis. Essentials in Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-319-57520-9_10

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  • DOI: https://doi.org/10.1007/978-3-319-57520-9_10

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-57519-3

  • Online ISBN: 978-3-319-57520-9

  • eBook Packages: MedicineMedicine (R0)

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