1. Intraocular Tuberculosis
Mamta Agarwal
Senior Consultant
Uveitis & Cornea Services
Sankara Nethralaya
Chennai

2. Ocular history
32 yr/ M
OD - C/O blurred vision x 4 months

3. General History
H/O fever, loss of hearing, weight & appetite since 2 months
Diagnosed as Tubercular Meningitis
Current Treatment
Oral antitubercular therapy

4. Clinical Presentation
BCVA OD – CF1m OS – 6/6
SLE OD – AC quiet, vit cells OS - normal

5. First Examination - FundusOD OS
Choroidal granuloma with
exudative retinal detachment
Healed choroidal granuloma

6. HRCT chest MRI brain
Miliary tuberculosis

7. Management Investigations ESR – 60 mm I hr
HRCT chest – S/O miliary Tuberculosis
MRI brain –Multiple tuberculoma in brain parenchyma
U/S
Retinochoroidal elevation with exudative RD
Treatment Oral steroid & Antitubercular therapy

8. Follow up 2 months
BCVA
OD – CF1m
OS – 6/6

9. Tubercular Choroidal granuloma
Final Diagnosis
Tubercular Choroidal granuloma

10. Ocular Tuberculosis
Extra pulmonary tuberculosis – Pleura, lymphnodes, liver, kidney, CNS, eyes.
Mechanism of disease
Hematogenous spread
Hypersensitivity reaction with distant focus of infection
Most common clinical manifestations
Choroidal mass %
Choroiditis/ chorioretinitis 27%
Vitritis %
Iridocyclitis 13%
Panuveitis %
Others – conjunctivitis, interstitial keratitis, scleritis, ocular adnexa & orbit involvement

11. Discussion Diagnosis of ocular TB is a diagnostic challenge.
Definite diagnosis – PCR/ Culture
Presumed Ocular Tuberculosis
Clinical history & findings
Ancillary tests
Therapeutic trial of anti tuberculosis treatment
No single, safe, sensitive, specific test exists.
Diagnostic tests like aqueous paracentesis or vitreous tap have lower sensitivities & risk of complications.

12. Conclusion HRCT chest is more sensitive & specific than X rays.
Mantoux test has limited sensitivity.
False positive in patients with non tuberculous mycobacterial infection & post BCG vaccination.
False negative in immunocompromised states.
Quantiferon tests fails to distinguish between active & latent infection. Useful in immunocompromised states, smear negative pulmonary TB.
PCR tests – Highly specific, low sensitive, invasive procedure.