1. Assist. Lecturer of Ophthalmology
Eales Disease
Rowayda M. Amin
Assist. Lecturer of Ophthalmology
Ahmed Souka, MD
Lecturer of Ophthalmology, Alexandria Univesity

2. Ocular History 29-year-old male
progressive decrease in visual acuity in both eyes over 2 weeks.
had commenced oral steroids 5 days prior to presentation with only a marginal improvement in VA and intraocular inflammation.

3. Ocular History
recurrent uveitis and argon laser treatment 5 years ago

4. First Presentation
BCVA was 4/60 in the right eye and 1/60 in the left,
bilateral panuveitis
extensive retinal vasculitis
complicated cataract
posterior synechae in the left eye

5. First Presentation - Right Fundus
VA: 4/60
2+ AC cell, mild flare
2+ vitreous cell, mild haze
extensive retinal vasculitis
Optic disc hyperemia
Peripheral laser scars
Chorioretinal and retinal infiltrates

6. First Presentation - Left Fundus
VA 1/60
+2 AC cell, mild flare
Poor view due to posterior
synechae, complicated cataract
and vitreous haze

7. Differential Diagnosis
Behcet´s disease
SLE
Sarcoidosis
Ocular tuberculosis/ Eales’ disease
Syphilis

8. Work-up CXR PPD Mantoux Tuberculin skin tests Routine blood work
S ACE, ANA, FTA, RPR
Meticulous review of systems
All unremarkable
PPD 18 mm induration despite oral steroids
Supporting a diagnosis of ocular TB.

10. Treatment standard course of antitubercular treatment
2 months of rifampicin, isoniazid, pyrazinamide, and ethambutol, followed by
4 months of rifampicin and isoniazid and
slow taper of oral steroid dose.

11. Follow-up dramatic improvement of uveitis and VA over a 4 week period
6 months after completing ATT, eyes remained quiet
VA of 6/36 RE and 3/60 LE

12. Right and left Fundus 4 weeks after begin of treatment

13. Conclusion
This case highlights the diversity of clinical presentations of TB uveitis which forms part of the differential of any chronic or recurrent uveitis.
TB is one of the few causes of uveitis with a definite effective treatment and where standard treatment with steroids alone could be sight threatening.
The diagnosis of ocular TB is based on clinical findings consistent with TB, positive tuberculin skin testing and absence of any other systemic disease to account for the uveitis.