Abstract
Ocular morbidity associated with systemic tuberculosis is common. The clinical picture varies from anterior uveitis, intermediate uveitis and posterior uveitis to even panuveitis. There is little data on the correlation between specific systemic presentations and the ocular inflammation. We conducted a retrospective review of the ocular findings in the case records of patients admitted with a diagnosis of miliary tuberculosis. These patients were then referred for a more detailed ophthalmic evaluation. We analysed the case records of patients with a clinical diagnosis of miliary tuberculosis over a 10-year period at Lilavati Hospital and Research Center, Mumbai. In total, 11 immunocompetent patients were identified. All 22 eyes showed normal findings on slit lamp examination. Dilated fundus examination showed single or multiple tubercles. In our cohort, the ocular findings were exclusively in the form of choroidal tuberculosis, either unilaterally or bilaterally. Slit lamp examination revealed no anterior segment inflammation Conclusions: We suggest that this pattern of choroidal/retinal tuberculosis in the absence of anterior and intermediate segment inflammation is specific for miliary tuberculosis and may be related to a specific immune response.
Highlights
Tuberculosis is a significant cause of uveitis, with published literature describing a spectrum of ocular inflammation that includes anterior uveitis, intermediate uveitis and posterior uveitis or even panuveitis in patients with different presentations of systemic tuberculosis
The common modes of clinical presentation of miliary tuberculosis included persistent fever, (7 patients: 4 males and 3 females with ages ranging from 4–73 years) or sepsis (4 patients: 3 females and 1 male with ages ranging from 16–71 years). 6 patients underwent a detailed evaluation soon after admission
Of the 1.7 billion individuals infected with tuberculosis, only 10 % will develop an active infection in their lifetime, due to a protective immune response that can be damaging to the tissues and is responsible for the clinical picture seen during active disease
Summary
Tuberculosis is a significant cause of uveitis, with published literature describing a spectrum of ocular inflammation that includes anterior uveitis, intermediate uveitis and posterior uveitis or even panuveitis in patients with different presentations of systemic tuberculosis. Little data exists on the correlation between specific systemic presentations and any ocular inflammation that may co-exist. Miliary tuberculosis is a specific systemic presentation that is commonly associated with ocular inflammation. We conducted a retrospective observational study of patients admitted with a diagnosis of miliary tuberculosis, to assess the specific patterns of any associated ocular inflammation. There is little data on the correlation between specific systemic presentations and the ocular inflammation. We conducted a retrospective review of the ocular findings in the case records of patients admitted with a diagnosis of miliary tuberculosis. These patients were referred for a more detailed ophthalmic evaluation. Slit lamp examination revealed no anterior segment inflammation Conclusions: We suggest that this pattern of choroidal/retinal tuberculosis in the absence of anterior and intermediate segment inflammation is specific for miliary tuberculosis and may be related to a specific immune response
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