Friday, January 20, 2017

Tuberculosis : Ocular Manifestations

Hello everyone !
This is a short post about the manifestations of Tuberculosis in the eye.
TB is associated with a lot of findings in the eye.
We can classify them as :
1. Disease related.
2. Therapy related.
Let's look at the first one.
1. Disease related :
A. Extra Ocular structures -
    I. Appendages :
       Eyelid - Lupus Vulgaris. Lid granuloma.
       Lacrimal apparatus - TB Dacryoadenitis. Dacryocystitis.
      
    II. Orbit :
         Orbital Cellulitis.
         Orbital Pseudotumor.
B. Ocular manifestations -
    
     I. Conjunctiva -
         Phlyctenular Conjunctivitis - due to hypersensitivity to Tuberculin. Seen as intense itching , discharge , redness and nodules.
     II. Cornea -
          Interstitial Keratitis
     III. Uvea -
          Granulomatous uveitis ( Chronic anterior Uveitis ). Shows Mutton Fat appearance.
          Choroiditis - Choroid Tubercles - classic of TB Uveitis. Tuberculoma may be seen. Miliary choroid nodules may be seen.
      IV. Retina -
            Eale's disease - may be a result of Hypersensitivity to Tuberculin. Although causality is not established clearly.
           Sub retinal Tubercles.
2. Therapy Related :
       A. Ethambutol - may cause Optic Neuritis - generally retrobulbar type. With Color Blindness.
      B. INH - Isoniazid can cause retrobulbar optic neuritis, although this is much rarer.
     C. Immune Reconstitution Inflammatory Syndrome - When a person recuperates from TB /HIV his immune system may become hyperactive and show Immunologically mediated uveitis.
Hope this helps !
Happy studying.
Stay awesome. 

~A.P.Burkholderia

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