Tuberculosis and the eye
- Sivakumar R Rathinam, FAMS, PhD
Sivakumar R Rathinam, FAMS, PhD
- Professor of Ophthalmology and Head of uveitis service
- Aravind Eye Hospital & PG Institute of Ophthalmology
- Section Editors
- C Fordham von Reyn, MD
C Fordham von Reyn, MD
- Section Editor — Tuberculosis; Nontuberculous Mycobacterial Infections
- Professor of Medicine
- Geisel School of Medicine at Dartmouth
- Jonathan Trobe, MD
Jonathan Trobe, MD
- Section Editor — Ophthalmology
- Professor of Ophthalmology and Visual Sciences
- Professor of Neurology
- University of Michigan Kellogg Eye Center
Tuberculosis (TB) is an infection caused by Mycobacterium tuberculosis that can cause disease in many organs, including the eye [1,2]. Ocular TB can involve any part of the eye and can occur with or without evidence of systemic TB. It generally develops following hematogenous spread from a primary focus but, in rare cases, it can also occur as a primary infection following epithelial injury. Establishing the diagnosis of TB in an extrapulmonary focus is a clinical challenge.
Issues related to ocular TB will be reviewed here. Issues related to other aspects of TB, including ocular toxicities of TB medications, are discussed in detail separately. (See related topics.)
Tuberculosis (TB) is an airborne communicable disease of major public health significance in many countries. General issues related to epidemiology of TB are discussed separately. (See "Epidemiology of tuberculosis" and "Epidemiology and pathology of miliary and extrapulmonary tuberculosis" and "Epidemiology and molecular mechanisms of drug-resistant tuberculosis".)
Most TB disease involves the lungs. Ocular TB usually represents extrapulmonary dissemination of infection. The incidence of ocular TB is uncertain due to difficulties in ocular sampling for microbiology and inexact diagnostic criteria [2,3]. Prior to the era of HIV/AIDS, two prospective studies of patients with TB admitted to a sanatorium noted ocular disease incidence of 1 to 2 percent [4,5]. Since the HIV/AIDS area, prospective surveys have noted the following:
●Among 100 patients with culture-positive TB in Spain who underwent systematic ophthalmologic evaluation, ocular TB was identified in 18 percent of cases . HIV coinfection was observed in 60 percent of patients, and more than half of patients had no symptoms referable to the eye.
- Thompson MJ, Albert DM. Ocular tuberculosis. Arch Ophthalmol 2005; 123:844.
- Yeh S, Sen HN, Colyer M, et al. Update on ocular tuberculosis. Curr Opin Ophthalmol 2012; 23:551.
- Helm CJ, Holland GN. Ocular tuberculosis. Surv Ophthalmol 1993; 38:229.
- Donahue HC. Ophthalmologic experience in a tuberculosis sanatorium. Am J Ophthalmol 1967; 64:742.
- Goldenburg M, Fabricant ND. The eye in the tuberculous patient. Trans Sect Ophthalmol Am Med Assn 1930; 135:8.
- Bouza E, Merino P, Muñoz P, et al. Ocular tuberculosis. A prospective study in a general hospital. Medicine (Baltimore) 1997; 76:53.
- Beare NA, Kublin JG, Lewis DK, et al. Ocular disease in patients with tuberculosis and HIV presenting with fever in Africa. Br J Ophthalmol 2002; 86:1076.
- Vasconcelos-Santos DV, Rao PK, Davies JB, et al. Clinical features of tuberculous serpiginouslike choroiditis in contrast to classic serpiginous choroiditis. Arch Ophthalmol 2010; 128:853.
- Gupta A, Bansal R, Gupta V, et al. Ocular signs predictive of tubercular uveitis. Am J Ophthalmol 2010; 149:562.
- Gupta V, Gupta A, Arora S, et al. Presumed tubercular serpiginouslike choroiditis: clinical presentations and management. Ophthalmology 2003; 110:1744.
- Rathinam SR, Lalitha P. Paradoxical worsening of ocular tuberculosis in HIV patients after antiretroviral therapy. Eye (Lond) 2007; 21:667.
- Madhavan HN, Therese KL, Gunisha P, et al. Polymerase chain reaction for detection of Mycobacterium tuberculosis in epiretinal membrane in Eales' disease. Invest Ophthalmol Vis Sci 2000; 41:822.
- Griffith DE, Aksamit T, Brown-Elliott BA, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007; 175:367.
- Pillai S, Malone TJ, Abad JC. Orbital tuberculosis. Ophthal Plast Reconstr Surg 1995; 11:27.
- Sen DK. Tuberculosis of the orbit and lacrimal gland: a clinical study of 14 cases. J Pediatr Ophthalmol Strabismus 1980; 17:232.
- Raina UK, Jain S, Monga S, et al. Tubercular preseptal cellulitis in children: a presenting feature of underlying systemic tuberculosis. Ophthalmology 2004; 111:291.
- Mohan K, Prasad P, Banerjee AK, Dhir SP. Tubercular tarsitis. Indian J Ophthalmol 1985; 33:115.
- Dinning WJ, Marston S. Cutaneous and ocular tuberculosis: a review. J R Soc Med 1985; 78:576.
- Madhukar K, Bhide M, Prasad CE. Tuberculosis of the lacrimal gland. J Trop Med Hyg 1991; 94:150.
- Panda A, Singhal V. Tuberculosis of lacrimal gland. Indian J Pediatr 1989; 56:531.
- Cook CD, Hainsworth M. Tuberculosis of the conjunctiva occurring in association with a neighbouring lupus vulgaris lesion. Br J Ophthalmol 1990; 74:315.
- Singh I, Chaudhary U, Arora B. Tuberculoma of the conjunctiva. J Indian Med Assoc 1989; 87:265.
- Fernandes M, Vemuganti GK, Pasricha G, et al. Unilateral tuberculous conjunctivitis with tarsal necrosis. Arch Ophthalmol 2003; 121:1475.
- Aclimandos WA, Kerr-Muir M. Tuberculous keratoconjunctivitis. Br J Ophthalmol 1992; 76:175.
- Sheu SJ, Shyu JS, Chen LM, et al. Ocular manifestations of tuberculosis. Ophthalmology 2001; 108:1580.
- Saini JS, Sharma A, Pillai P. Scleral tuberculosis. Trop Geogr Med 1988; 40:350.
- Nanda M, Pflugfelder SC, Holland S. Mycobacterium tuberculosis scleritis. Am J Ophthalmol 1989; 108:736.
- Wroblewski KJ, Hidayat AA, Neafie RC, et al. Ocular tuberculosis: a clinicopathologic and molecular study. Ophthalmology 2011; 118:772.
- Vasconcelos-Santos DV, Zierhut M, Rao NA. Strengths and weaknesses of diagnostic tools for tuberculous uveitis. Ocul Immunol Inflamm 2009; 17:351.
- World Health Organiation. Nucleic Acid Amplification Technology for Rapid and Simultaneous Detection of Tuberculosis and Rifampicin Resistance: Xpert MTB/RIF System. Policy Statement http://whqlibdoc.who.int/publications/2011/9789241501545_eng.pdf (Accessed on March 04, 2013).
- CLINICAL MANIFESTATIONS AND DIAGNOSIS
- Intraocular TB
- - Uveitis
- Immune recovery
- - Retinal TB
- - Differential diagnosis
- TB of the external eye
- - Orbit
- - Eyelid
- - Lacrimal gland
- - Conjunctiva
- - Keratoconjunctivitis
- - Sclera
- LABORATORY EVALUATION