Last Updated on February 23, 2023 by Shabnam Sengupta
TB, or Mycobacterium tuberculosis, is an infection that can harm different body organs, including the eye. It is important to note that blindness and vision loss are unforeseen side effects of tuberculous meningitis. However, in TB patients, cataract, refractive error, pterygium, glaucoma, presbyopia, maculopathy, and allergic conjunctivitis were the most frequently observed ocular conditions. Ocular tuberculosis is the name for an M. tuberculosis infection that can affect any part of the eye. Ocular tuberculosis, which has a range of clinical manifestations that can impair vision, has the potential to affect almost every ocular tissue. As a result, this article gives a summary of the causes, symptoms, and treatment options for the ocular TB-related eye impairment.
What principal factors give rise to ocular tuberculosis?
Ocular tuberculosis is a clinical illness caused by Mycobacterium tuberculosis. It has a wide range of transmission routes and can infect almost any ocular tissue. Similar to how syphilis can imitate various skin conditions, TB should be thought of as “the great imitator” of ocular pathologies.
Three disease modes have been identified for ocular tuberculosis:
1. Direct ocular infection from an external source, such as contact with the lids or conjunctiva, can occur.
2. M. tuberculosis spreading from an extrapulmonary or pulmonary source of infection through the blood.
3. An eye-related allergic reaction following exposure to TB antigens.
What symptoms does ocular tuberculosis exhibit clinically?
Any form of ocular inflammation can be a symptom of ocular TB. Patients may describe unilateral or bilateral acute or chronic inflammation. Additionally, patients may experience red eyes, floaters, flashes, or headaches. With choroid tubercles close to the macula, visual acuity is compromised and it may cause photosensitivity. Notably, the absence of visual symptoms does not rule out ocular TB because small tubercles in the peripheral fundus may be clinically silent.
It also affects nearly all of the ocular tissues and has a wide range of clinical manifestations. These include choroidal tuberculoma, infectious multifocal serpiginoid choroiditis (MSC), anterior and intermediate uveitis, retinal vasculitis, scleritis, and optic neuritis.
What treatment options are available for treating ocular tuberculosis?
By conducting a thorough clinical and diagnostic examination, ocular TB should be confirmed. Treatment for ocular tuberculosis generally follows that for pulmonary TB. Rifampicin, isoniazid, pyrazinamide, and ethambutol are the four medications used in the treatment, and they are given daily for two months, followed by four months of rifampicin and isoniazid. Consider multidrug resistance in TB and continue treatment in collaboration with an infectious disease specialist if the patient doesn’t improve after three to four weeks
The fact that ATT medications can have damaging consequences for the eyes must be understood. Ethambutol causes dose-dependent ocular toxicity, including disc oedema, extraocular muscle paresis, optic neuritis, and photophobia.
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