Tuberculous uveitis

Abstract

In recent years, ocular involvement due to TB has re-emerged. Tuberculous uveitis is a readily treatable disease and the consequences of delay in either ocular or systemic diagnosis can be very serious for the patient. It is important to have a high index of suspicion of the diagnosis in patients with unexplained chronic uveitis and this will be influenced by the socio-economic circumstances, family history, ethnic origin, and previous medical history of the patient. Treatment with antituberculous therapy combined with systemic corticosteroids resolves inflammation without recurrences after medical therapy.

Keywords: Diagnosis; Treatment; Tuberculosis Uveitis.

Figure 1

Slit-lamp biomicroscopy of a 45-year-old woman with strongly positive tuberculin skin test (22 mm induration) shows mutton-fat keratic precipitates, posterior synechiae and anterior chamber fibrinous exudate (top). Fundus photograph shows optic disc swelling and hyperemia (bottom left). Indocyanine green angiography shows choroidal hypofluorescent areas (bottom left)

Figure 2

Right eye of a 21-year-old woman with strongly positive tuberculin skin test (22 mm induration) and a family history of tuberculosis shows large iris granulomas in the inferior angle

Figure 3

A 25-year-old woman with strongly positive tuberculin skin test (15 mm induration). (a) Slit-lamp biomicroscopy shows bilateral mutton-fat keratic precipitates and posterior synechiae in the left eye; (b) Fundus photographs show yellow lesions and disc swelling and hyperemia; (c) Optical coherence tomography of the left eye shows cystoid macular edema (d) Fluorescein angiography shows leakage from optic nerve head and retinal vessels; (e) Indocyanine green angiography shows choroidal hypofluorescent areas

Figure 4

Right eye of a 45-year-old woman with strongly positive tuberculin skin test (20 mm induration). Fluorescein angiography shows leakage from optic nerve head and cystoid macular edema (top). Optical coherence tomogrqaphy shows cystoid macular edema. Central macular thickness was 588 μm. Visual acuity was 20/100 (bottom left). Two months after starting antituberculous therapy and systemic corticosteroids, optical coherence tomography displays normal anatomy of the macula with reduction of central macular thickness to 239 μm. Visual acuity improved to 20/30 (bottom right)

Figure 5

The right eye of a 28-year-old man with strongly positive tuberculin skin test (20 mm induration) shows thick perivenous sheathing with intraretinal hemorrhages, cotton-wool spots, neovessels on optic nerve head, and preretinal hemorrhage above optic nerve head (left). Fluorescein angiography shows leakage from the retinal veins, and neovessels on optic nerve head and retinal nonperfusion (right)

Figure 6

(a) Right eye of a 25-year-old man with strongly positive tuberculin skin test (16 mm induration) shows perivenous sheathing with intraretinal hemorrhages and neovessels nasal to optic nerve head (top). Fluorescein angiography shows leakage from the retinal veins and retinal nonperfusion (middle). Optical coherence tomography shows macular edema (bottom); (b) Ten months after treatment with antituberculous therapy, systemic corticosteroids, and scatter laser photocoagulation. Optical coherence tomography displays normal anatomy of the macula

Figure 7

(a) Right eye of a 33-year-old man with strongly positive tuberculin skin test (24 mm induration) shows multifocal choroiditis. Visual acuity was 20/200 (top left). Optical coherence tomography shows overlying exudative retinal detachment (top right). Fluorescein angiography shows hypofluorescence in the early phase with staining in the late phase (bottom); (b) Nine months after starting antituberculous therapy and systemic corticosteroids. Optical coherence tomography displays resolution of exudative retinal detachment. Visual acuity improved to 20/20

Figure 8

Right eye of a 31-year-old woman with strongly positive tuberculin skin test (18 mm induration) shows multifocal choroiditis (top). Fluorescein angiography shows early hypofluorescence and late hyperfluorescence (middle). Indocyanine green angiography shows hypofluorescent lesions throughout (bottom)

Figure 9

(a) Right eye of a 54-year-old man with strongly positive tuberculin skin test (22 mm induration) shows multifocal choroiditis. Visual acuity was 20/60. Fundus microperimetry shows decreased sensitivity (The local sensitivity of the measured points is shown in two ways-first as a colour code with dark green for best sensitivity and second as a numerical code in dB from 0 to 20 with 20 meaning best sensitivity. (b) Six months after starting antituberculous therapy and systemic corticosteroids. Visual acuity improved to 20/20 and microperimetry shows improved sensitivity

Figure 10

Right eye of a 60-year-old woman with strongly positive tuberculin skin test (30 mm induration) shows choroidal granulomas (top). Fluorescein angiography shows early hyperfluorescence and increase in hyperfluorescence during the late phase (middle). Indocyanine green angiography shows hypofluorescence throughout corresponding to the large granuloma (bottom)