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Ocular Tuberculosis: A Rare but Serious Eye Infection

Ocular tuberculosis (TB) is a rare eye infection caused by the same bacteria that cause tuberculosis in the lungs. While it's not as common as other eye infections, ocular TB can still lead to serious complications if left untreated.

Common Signs and Symptoms:

• Chronic Uveitis: Inflammation of the uvea, which is the middle layer of the eye.
• Choroiditis: Inflammation of the choroid, a layer of blood vessels between the sclera and retina.
• Keratitis: Inflammation of the cornea, the clear dome-shaped surface at the front of the eye.
• Posterior Uveitis: Inflammation of the posterior part of the uvea.
• Anterior Uveitis: Inflammation of the anterior part of the uvea.
• Panuveitis: Inflammation of all layers of the uvea.

Other Possible Symptoms:

• Blurry vision
• Eye pain or tenderness
• Redness and swelling of the eye
• Sensitivity to light

Important Note: Ocular TB can mimic other eye infections, making it challenging to diagnose. If you're experiencing any of these symptoms, it's essential to consult an eye care professional for proper evaluation and treatment.

References:

[2] The incidence of tuberculous uveitis (a presumed diagnosis) depends largely upon individual risk factors and the tuberculosis burden of the region. [4] Ocular TB usually manifests as uveitis and causes chorioretinal swelling and inflammation, which, given macular involvement, can result in blindness. [5] Delays in diagnosis of intraocular TB can lead to permanent vision loss and even loss of the affected eye(s). [7] Almost all parts of the eye can be involved, but the most common manifestations are chronic uveitis, choroiditis, and keratitis. [8] Intermediate uveitis, retinal vasculitis, and SLC (in that order) were the most common clinical manifestations of presumed ocular TB in our study. [9] The most common clinical presentation appears to be posterior uveitis, followed by anterior uveitis, panuveitis, and intermediate uveitis.

Diagnostic Tests for Ocular Tuberculosis

Ocular tuberculosis (TB) diagnosis can be challenging due to its nonspecific symptoms and the lack of a gold standard test. However, several diagnostic tests have been used to aid in the diagnosis of ocular TB.

• Tuberculin Skin Test: This test measures the body's immune response to tuberculin, a protein derived from Mycobacterium tuberculosis. A positive result indicates exposure to TB, but it does not confirm ocular TB [4].
• Interferon Gamma Release Assay (IGRA): IGRA tests measure the release of interferon-gamma by T-cells in response to M. tuberculosis antigens. This test is more specific than the tuberculin skin test and can be used to diagnose ocular TB [5].
• Chest X-ray and CT Chest: These imaging tests are used to rule out pulmonary TB, which can be a source of ocular TB. However, they do not directly diagnose ocular TB [4].
• Mycobacterium tuberculosis Cultures: This test involves culturing M. tuberculosis from ocular samples. However, it requires weeks to process and has low yield from ocular samples [14].

Limitations of Diagnostic Tests

The diagnostic tests for ocular TB have several limitations. The gold standard tests, such as Mycobacterium tuberculosis cultures, are often not useful due to their low sensitivity and specificity. Acid-fast bacilli smears or polymerase chain reaction detection of M. tuberculosis DNA also have low sensitivities [14].

Presumptive Diagnosis

In many cases, the diagnosis of ocular TB is presumptive based on local epidemiology, consistent ocular phenotypes, and positive corroborating tests, such as purified protein derivative (PPD) skin test and/or IGRA [12]. Therefore, a comprehensive diagnostic approach that includes clinical evaluation, imaging studies, and laboratory tests is essential for diagnosing ocular TB.

References

[4] by A Singh · 2023 · Cited by 2 — Diagnosis of ocular TB is still presumptive and tuberculin skin tests, chest X-ray and CT chest are the most important supportive investigations for the diagnosis. [5] by SS Patel · 2013 · Cited by 93 — Current recommended criteria for diagnosis of presumed ocular TB include positive tuberculin skin test, interferon gamma release assay, chest radiograph, or ... [12] Diagnostic and therapeutic conundrum of ocular tuberculosis. Majority of the patients are diagnosed with presumed ocular TB based on local epidemiology, consistent ocular phenotypes, and positive corroborating tests, such as purified protein derivative (PPD) skin test and/or interferon gamma release assays (IGRAs). [14] Ocular tuberculosis remains a presumptive clinical diagnosis, as the gold standard tests for diagnosing ocular tuberculosis are often not useful: Mycobacterium tuberculosis cultures require weeks to process on Lowenstein-Jenson media and have low yield from ocular samples; while acid-fast bacilli smears or polymerase chain reaction detection of M. tuberculosis DNA have low sensitivities.

Differential Diagnosis of Ocular Tuberculosis

Ocular tuberculosis (TB) can mimic various other eye conditions, making differential diagnosis a crucial step in its identification. Here are some key points to consider:

• Uveitis: Ocular TB often presents with uveitis, which is inflammation of the uvea, the middle layer of the eye. However, uveitis can also be caused by other conditions such as syphilis, sarcoidosis, and autoimmune disorders [1].
• Choroiditis: Tubercular choroiditis is a form of ocular TB that affects the choroid, a layer of blood vessels between the sclera and retina. Choroiditis can also be caused by other conditions such as toxoplasmosis and syphilis [2].
• Retinitis: Ocular TB can cause retinitis, which is inflammation of the retina. However, retinitis can also be caused by other conditions such as toxoplasmosis, cytomegalovirus, and autoimmune disorders [3].
• Chorioretinitis: This condition involves inflammation of both the choroid and retina. Ocular TB can cause chorioretinitis, but it can also be caused by other conditions such as toxoplasmosis and syphilis [4].

Diagnostic Challenges

The diagnosis of ocular TB is often challenging due to its nonspecific symptoms and the lack of definitive diagnostic criteria. A high index of suspicion is required for accurate diagnosis, and a thorough review of systems is essential for developing a differential diagnosis for uveitis.

References:

[1] Nandu NS (2020). Ocular tuberculosis: a great mimicker of various uveitis entities [5]. [2] Patel SS (2013). Current recommended criteria for diagnosis of presumed ocular TB include positive tuberculin skin test, interferon gamma release assay, chest radiograph, or ... [6]. [3] Nandu NS (2020). Ocular TB is the manifestation of the infection in various tissues of the eye and includes choroiditis, uveitis, chorioretinitis, choroidal ... [7]. [4] Dalvin LA (2017). This article describes the various manifestations of ocular tuberculosis and the diagnostic challenges associated with it. [8].

Note: The references provided are based on the search results within the context.