Tuberculosis - I.T. Pyatnochka 2005

Extrapulmonary tuberculosis
Eye tuberculosis

Ocular tuberculosis is not an uncommon form of Extrapulmonary tuberculosis, affecting children, adolescents, and adults alike.

Mycobacteria reach the membranes of the Eyeball via the bloodstream, triggering vascular inflammation characterized by The formation of tuberculous nodules. Alternatively, a hypersensitivity (allergic) reaction may occur, causing diffuse inflammation in the outer Tunics of the eye without the presence of specific granulomas. Thus, both allergic and focal tuberculous processes are distinguished. The allergic form frequently accompanies Primary tuberculosis and is observed predominantly in children and young adults. Phlyctenules may appear on the conjunctiva, potentially accompanied by superficial keratitis. On the conjunctiva and sclera, phlyctenules present as grayish-yellow nodules surrounded by a mild hyperemic zone. These nodules can break down into small ulcers that typically heal within 2-3 weeks.

Superficial allergic keratitis is characterized by the appearance of grey infiltrates and circumcorneal vascular injection. All forms of allergic tuberculous processes are accompanied by a positive tuberculin Skin test.

The hematogenous form most commonly affects the uveal tract, although any part of the eye may be involved. Choroiditis, which is Tuberculosis of the posterior uvea, accounts for 70-80% of cases. When the inflammation extends to the retina, chorioretinitis develops.

Tuberculous scleritis, keratitis, and iridocyclitis occur rarely.

Diagnosing ocular tuberculosis is often challenging. Alongside the Clinical presentation, physicians must consider a positive tuberculin reaction and evidence of tuberculosis in other Organs. The Koch test is frequently helpful in Diagnosis, as an active ocular tuberculosis lesion will visually exhibit a focal reaction.

The mainstay of Treatment is anti-mycobacterial therapy administered for 6-8 months via intravenous, parenteral, and local routes, combined with Vitamins, desensitizing agents, and supportive therapies.