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Retinal and Choroidal Manifestations of Tuberculosis

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Retinal and Choroidal Manifestations of Selected Systemic Diseases

Abstract

Ocular tuberculosis has been recognized from the nineteenth century onward due to the work of Gueneau de Mussy, Jaeger, Fraenkel, and Bouchut. Ocular tuberculosis had a high prevalence worldwide in the twentieth century, but this prevalence has reduced significantly in the western hemisphere, a decline that has paralleled the decline of tuberculosis as a common systemic infection. In recent times, the prevalence varies from 18% (Spain) to 1.39% (India). The advent of the human immunodeficiency virus (HIV) epidemic has led to an increase in the prevalence of ocular tuberculosis to up to 23.5%. Manifestations vary depending upon the ocular tissue involved. The manifestations can either be due to direct tissue infection or be hypersensitivity reactions. Rare manifestations include the eyelids (lupus vulgaris), the conjunctiva (conjunctivitis), cornea (ulcers and phlyctenulosis), and the sclera (scleritis). The most common manifestations include uveal involvement in the form of tubercles, tuberculomas, and serpiginous-like choroiditis. Other manifestations include orbital apex syndrome and lesions associated with neurotuberculosis (disc edema and sixth nerve palsies). The diagnostic workup of patients with suspected ocular tuberculosis has both systemic and ocular components. The systemic investigations include (1) radiography: (a) chest X-rays and computed tomography of the chest and (b) abdominal CT scan or ultrasonography; (2) Mantoux testing; and (3) interferon-γ(gamma) release assays (IGRA). Ocular investigations of ocular fluids or tissue biopsies include (1) microscopy, (2) culture, and (3) PCR (polymerase chain reaction) techniques. The treatment includes the use of topical, periocular, or systemic corticosteroids with a four-drug regimen of antitubercular therapy.

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Authors and Affiliations

  1. Department of Ophthalmology, Lilavati Hospital and Research Center, A791, Bandra Reclamation, Bandra (West), Mumbai, Maharashtra, 400052, India

    Salil Mehta M.S., D.N.B.

  2. Retina, Vitreous and Uvea Department, Banker’s Retina Clinic and Laser Centre, 5 Subhash Society, Behind Ishwar Bhuvan, Navrangpura, Ahmedabad, Gujarat, 380009, India

    Alay S. Banker M.D. & Rohan Chauhan D.O.

Authors
  1. Salil Mehta M.S., D.N.B.
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  2. Alay S. Banker M.D.
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  3. Rohan Chauhan D.O.
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Corresponding author

Correspondence to Salil Mehta M.S., D.N.B. .

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Editors and Affiliations

  1. Johns Hopkins University, School of Medicine, The Retina Division,Wilmer Eye Institute, Al-Oruba Street, PO Box 7191, Riyadh, 1010, Saudi Arabia

    J. Fernando Arévalo

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Mehta, S., Banker, A.S., Chauhan, R. (2013). Retinal and Choroidal Manifestations of Tuberculosis. In: Arévalo, J. (eds) Retinal and Choroidal Manifestations of Selected Systemic Diseases. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3646-1_5

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  • DOI: https://doi.org/10.1007/978-1-4614-3646-1_5

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