Orbital and external ocular manifestations of Mycobacterium tuberculosis: A review of the literature

Abstract

Tuberculosis (TB) is an airborne infectious disease caused by Mycobacterium tuberculosis that most commonly affects the lungs. However, extrapulmonary manifestations of TB can affect the eye and surrounding orbital tissues. TB can affect nearly any tissue in the eye, and a high index of suspicion is required for accurate diagnosis. Systemic anti-tuberculosis treatment is required in cases of ocular TB, and steroids are sometimes necessary to prevent tissue damage secondary to inflammation. Delays in diagnosis are common and can result in morbidities such as loss of an affected eye. It is important for ophthalmologists and infectious disease specialists to work together to accurately diagnose and treat ocular TB in order to prevent vision loss. This article reports the various known presentations of orbital and external ocular TB and reviews important elements of diagnosis and treatment.

Keywords: Eye; Mycobacterium; Ocular; Orbit; Tuberculosis.

Fig. 1

Orbital tuberculosis presenting as proptosis. (A) Caldwell view x-ray shows bony destruction of the greater wing of the sphenoid (arrow). (B) B-scan ultrasonography reveals a retroorbital hypoechoic area in the extraconal space (arrow). (C) Axial contrast-enhanced CT demonstrates left-sided proptosis, lacrimal abscess (arrow), and preseptal thickening (arrowhead). (D) Coronal, contrast-enhanced CT scan further illustrates destruction of the greater wing of the sphenoid (arrow) and intracranial extension (arrowhead) .

Fig. 2

Orbital tuberculosis with cranial extension and extradural abscess formation. (A) Caldwell view x-ray shows loss of definition of the greater wing of the sphenoid (arrow). (B–D) Axial (B) and coronal (C, D) contrast-enhanced CT scans reveal a right-sided extraconal and lacrimal abscess (asterisk in B, C), an intracranial extradural abscess (arrowhead), and an abscess in the infratemporal fossa region (double arrowhead). (C, D) Irregularity and sclerosis of the sphenoid and zygomatic bones (arrow) is also seen .

Fig. 3

Tuberculosis involvement of the lacrimal gland. (A) Axial contrast-enhanced CT scan shows a left lacrimal abscess (asterisk). (B, C) Coronal CT scans reveal irregularity, destruction, thickening, and sclerosis of the adjacent frontal and zygomatic bones (arrow) .

Fig. 4

Eyelid involvement of tuberculosis. (A) Left lower eyelid wound with submandibular lymphadenitis in a patient with swollen, erythematous left lower eyelid with delayed eyelid wound healing after 1 week of incision and curettage for presumed chalazion. (B) Fluctuant, tender submandibular swelling (arrowhead, marked) in the same patient that developed 1 week after the photograph in A was taken .

Fig. 5

Lymphadenopathy and conjunctivitis caused by direct inoculation with M. tuberculosis. (A) Preauricular lymphadenopathy. (B) Tarsal hypertrophy indicative of conjunctivitis .

Fig. 6

Tuberculosis manifesting as a conjunctival nodule in a 26-year-old female .

Fig. 7

Nodular scleritis caused by tuberculosis. (A) External photograph shows scleral nodules nasally and superiorly in the right eye. (B) Pathology and hematoxylin–eosin staining reveals a mixed inflammatory infiltrate in the sclera consisting of lymphocytes, plasma cells, and polymorphonuclear leukocytes with scleral necrosis. (C) A higher magnification of the hematoxylin–eosin stain reveals areas of scleral collagen necrosis .

Fig. 8

Tuberculous scleritis in a 52-year-old female .

Fig. 9

A Ziehl–Neelsen stain reveals acid-fast bacilli, consistent with M. tuberculosis.

Fig. 10

A reactive Mantoux skin test is consistent with but not diagnostic of M. tuberculosis infection .