Ocular Manifestations of Tuberculosis involving the Uvea: a case series

Abstract

Purpose: Ocular tuberculosis affects 1-2% of the TB population, with TB uveitis most commonly seen. This series aims to look at different manifestations of tuberculosis in the eye and the different diagnostics tests used to make the diagnosis. Methods: Patients diagnosed with ocular TB between 2017 to 2019 were reviewed. The patients’ demographics, clinical features, investigations and treatment were collected. Results: 10 patients aged between 39 and 71 were reviewed. The ocular manifestations included unilateral panuveitis or posterior uveitis (50%), recurrent unilateral anterior uveitis (40%), unilateral posterior uveitis (40%), bilateral panuveitis (20%), serpiginous choroiditis (20%), and unilateral vasculitis (20%) or a combination of signs. Tuberculosis tests were positive in 6 out of 8 Mantoux tests (75%), 4 out of 4 T-spot tests (100%), 3 out of 3 QuantiFeron-TB gold tests (100%), 1 out of 9 chest x-rays (11%), positive in 1 out of 1 lymph node biopsy (100%) and 0 out of 2 aqueous fluid PCR (0%). All other virus serology tests were negative. With anti-TB treatment prescribed in 9 patients, side effects occurred in 2 patients, including disc swelling and drug-induced hepatitis. Discussion and Conclusions: Ocular TB infections may manifest in a variety of forms, involving different parts of the eye at different presentations. The diagnosis in suspicious cases requires multimodal investigations where a negative chest X Ray cannot rule out ocular TB infections especially in an endemic region like Hong Kong.