Acute, unilateral panuveitis OD with granulomatous anterior component
Viral: HSV 1/2, VZV, CMV
Bacterial: TB, syphilis, cat-scratch
Ocular seeding via hematogenous spread at time of infection prior to adaptive immune response
Primary site uveal tract
Latent then reactivation with clinical disease
Inflammatory response to circulating bacterial antigens
Ocular TB is Active TB
Initiate systemic antibacterial therapy with assistance of IM/ID
Adjuvant topical and/or systemic steroids in most cases
Initiation of steroids necessitates antibacterial therapy to reduce risk of worsening disease
Prognosis and Future Directions
Started on Bactrim DS empirically and PF QID/atropine BID
Returns 1wk VA 20/40: Continued vitreous haze but significantly improved
Started on RIPE after discussion with ID Pending follow up after initiation of therapy
Ocular TB can present in nearly any form with uveitis being the most common
Accurate diagnosis remains a challenge and requires a combination of exam and diagnostic testing
Clinical suspicion should remain high, especially in patients from endemic areas
Patients frequently respond to a combination of antibacterial and corticosteroids
International partnerships are actively working to better define and understand ocular TB
World Health Organization. Global tuberculosis report 2013. Geneva, Switzerland: World Health Organization, 2013
Zimmerman MR. Pulmonary and osseous tuberculosis in an Egyptian mummy. Bull N Y Acad Med. 1979 Jun; 55(6):604-8
Ranjita, S., Loaye, A. S., & Khalil, M. (2011). Present Status of Nanoparticle Research for Treatment of Tuberculosis. Journal of Pharmacy and Pharmaceutical Sciences, 14(1), 100–116.
Skeiky, Y. A. W., & Sadoff, J. C. (2006). Advances in tuberculosis vaccine strategies. Nature Reviews Microbiology, 4(6), 469–476.
Barberis I et al (2017). The history of tuberculosis: from the first historical records to the isolation of Koch’s bacillus. J Prev Med Hyg. 58(1): E9–E12.
Ernst JD (2012) The immunological life cycle of tuberculosis. Nature Reviews Immunology. 12, 581–591.
Guirado E and Schlesinger LS (2013) Modeling the Mycobacterium tuberculosis granuloma – the critical battlefield in host immunity and disease. Front. Immunol. 4:98. doi: 10.3389/fimmu.2013.00098.
MacNeil A et al (2019) Global Epidemiology of Tuberculosis and Progress Toward Achieving Global Targets — 2017. MMWR 68(11):263-266
Albert DM and Raven ML (2016) Ocular tuberculosis. Microbiol Spectra. 4(6):doi:10.1128/microbiolspec.TNMI7-0001-2016
Basu S et al (2015) Pathogenesis and Pathology of Intraocular Tuberculosis. Ocular Immuno & Inflam. 23(4): 353–357
Biswas J et al (2016) Polymerase chain reaction for Mycobacterium tuberculosis DNA detection from ocular fluids in patients with various types of choroiditis in a referral eye center in India. Indian J Ophthalmol. Dec;64(12):904-907
Agarwal A et al (2019) The Collaborative Ocular Tuberculosis Study (COTS)-1 Report 3: Polymerase Chain Reaction in the Diagnosis and Management of Tubercular Uveitis: Global Trends. Ocul Immunol Inflamm. 27(3):465-473
Agarwal A et al (2019) Standardization of Nomenclature for Ocular Tuberculosis – Results of Collaborative Ocular Tuberculosis Study (COTS) Workshop. Ocul Immunol Inflamm. 00(00):1-11
Testi I et al (2019) Tubercular Uveitis: Nuggets from Collaborative Ocular Tuberculosis Study (COTS)-1. Ocul Immunol Inflamm 25:1-9
Agrawal R et al (2020) Collaborative Ocular Tuberculosis Study (COTS) Consensus Guidelines on the Management of Tubercular Uveitis – Report 1: Guidelines for Initiating Anti-Tubercular Therapy in Tubercular Choroiditis. Ophthalmology Accepted, pre-publication