Features of tuberculosis in eye

Reading File

Finding Sources

Searching PubMed

ocular tuberculosis clinical features

Reading File

Searching Images

ocular tuberculosis uveitis choroidal tubercle

Searching PubMed

ocular tuberculosis uveitis

Reading File

Loading Image

I now have comprehensive content from Kanski's Clinical Ophthalmology and clinical images. Here is a complete, organized answer.

Ocular Tuberculosis — Clinical Features

Mycobacterium tuberculosis reaches the eye haematogenously from a primary pulmonary focus. Importantly, ocular involvement commonly occurs without clinically overt systemic disease, so the absence of active pulmonary TB does not exclude the diagnosis. Immune deficiency (including HIV) is a key risk factor, and atypical mycobacteria (e.g., M. avium) may cause disease in immunocompromised patients.

1. Anterior Segment

Feature	Details
Anterior uveitis	Most common; typically granulomatous with mutton-fat keratic precipitates (KPs)
Iris nodules	Koeppe (pupil margin) and Busacca (iris stroma) nodules
Posterior synechiae	Broad-based PS can form
Phlyctenulosis	Hypersensitivity reaction at limbus; nodular lesion with surrounding injection
Interstitial keratitis	Stromal corneal inflammation
Scleritis	Granulomatous nodular or diffuse
Conjunctivitis	Rare; phlyctenular conjunctivitis more typical

2. Posterior Segment (Most Distinctive Features)

a. Choroidal Granuloma (Tubercle/Tuberculoma)

Focal, elevated dome-shaped yellow-white lesions — may be unilateral or bilateral, solitary or multiple.

Fig. 12.52A — Choroidal granuloma (Kanski's Clinical Ophthalmology, 10th ed.)

A large abscess-like tubercle is termed a tuberculoma
In AIDS, extensive choroidal infiltration can occur
Choroidal tubercles on fundoscopy are pathognomonic of miliary TB (Tintinalli)

Active choroidal granuloma with large yellowish-white mass and vitritis

Color fundus: large choroidal granuloma temporal to disc with subretinal exudates and vitreous haze

b. Serpiginoid (Serpiginous-like) Choroiditis

A pattern increasingly recognized as strongly suggestive of TB — multifocal choroiditis spreading centrifugally in a serpiginous pattern. Choroiditis tracking retinal vessels has reasonable specificity for TB.

Serpiginoid tuberculous choroiditis — serpentine inflammatory lesion

Fig. 12.53A — Serpiginoid tuberculous choroiditis with superior granuloma (Kanski's, 10th ed.)

c. Retinal Vasculitis (Periphlebitis — Eales-type)

Predominantly venous (periphlebitis)
Retinal haemorrhages are common
Vascular occlusion → extensive ischaemia → preretinal/disc neovascularization
Eales disease (peripheral periphlebitis with neovascularization) is hypothesized to represent a hypersensitivity reaction to TB

Occlusive tuberculous periphlebitis with superior retinal branch occlusion

Fig. 12.54A — Occlusive tuberculous periphlebitis: superior retinal branch occlusion (Kanski's, 10th ed.)

d. Multimodal Imaging Panel

Multimodal imaging of ocular TB: fundus, FAF, OCT, FFA, ICGA showing choroidal tubercles

(A) Color fundus: multiple ill-defined yellow subretinal tubercles; (B) FAF: hyperautofluorescent peripapillary edema; (C) OCT: serous RPE detachment with choroidal "contact sign"; (D–E) FFA: early hypofluorescence → late leakage; (F–G) ICGA: persistent hypocyanescent spots indicating choroidal perfusion deficits

e. Choroidal Tubercle — Progression/Healing

Four-panel fundus montage showing choroidal tubercle resolving over 4 months to atrophic scar

Healing progression: active yellow-white lesion (a) → pigmented border (b) → consolidation (c) → pale atrophic "parchment" scar (d) over 4 months

3. Vitreous

Viritis is very common — may be secondary to anterior, intermediate, or posterior foci
Macular complications: cystoid macular oedema and epiretinal membrane formation

4. Adnexal / Other Manifestations

Structure	Feature
Eyelids	Reddish-brown nodules — lupus vulgaris
Optic nerve	Optic neuropathy, neuroretinitis
Retina	Exudative retinal detachment

5. Investigation

Test	Notes
Tuberculin skin test (TST/Mantoux)	Positive within 48 hours in active/latent TB
IGRA (T-SPOT.TB / QuantiFERON)	~80% sensitivity; not affected by BCG vaccination; detects latent TB
Aqueous/vitreous PCR	Low yield but most specific; ZN stain for AFB on Ziehl-Neelsen, culture on Löwenstein-Jensen medium
Chest X-ray / CT / PET-CT	Systemic assessment
HIV testing	Mandatory
Sputum PCR	For active pulmonary disease

6. Treatment

Four-drug anti-TB therapy (HRZE initially) prescribed and monitored by a TB specialist
Ethambutol requires optic neuropathy monitoring
Rifabutin can paradoxically cause anterior uveitis
Concomitant topical and systemic steroids reduce inflammation-induced damage, especially in early weeks (also mitigate paradoxical worsening)
Laser photocoagulation to ischaemic retina for preretinal neovascularization
Anti-TB therapy in latent TB-associated uveitis halves recurrence risk and delays first recurrence

Key diagnostic pearl: Ocular TB is frequently a diagnosis of exclusion — made clinically based on TB exposure history, positive immunological tests, and response to treatment, in the absence of other identifiable causes. Choroidal tubercles on fundoscopy remain pathognomonic of miliary TB.

Sources: Kanski's Clinical Ophthalmology: A Systematic Approach, 10th ed., pp. 498–499; Tintinalli's Emergency Medicine, 9th ed.

Eye manifestation of syphillis

Finding Sources

Searching PubMed

ocular syphilis clinical manifestations

Reading File

Searching Images

ocular syphilis uveitis interstitial keratitis fundus

Finding Sources

Loading Image

Reading File

Finding Sources

Reading File

Loading Image

This is a shared conversation. Sign in to Orris to start your own chat.