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.

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