Ocular Tuberculosis; Different Clinical Presentation

Purpose: To present the diversity of clinical features, diagnostic approach with treatment outcome in four cases of ocular tuberculosis. Methods: An observational case series of four cases of ocular tuberculosis. Detail history, thorough ocular and systemic examination, Fundus fluorescein angiography, B-scan untrasonography ; Optical Coherence tomography scan, Erythrocyte Sedimentation Rate, Skin test for tubercle protein, histopathological examination of biopsy from lesion were performed according to the cases. Diagnosis was made by clinical history, ocular findings, appropriate ancillary tests and laboratory investigations according to the merit of the diseases. Response to anti tuberculous therapy (ATT) were observed which gave an anchor to the diagnosis. Results: Among four cases of ocular tuberculosis ,three were female last case was male and all of them were at or under the age of fourty. Two patients had extra ocular manifestation; one was tuberculous dacryoadenitis & other was tuberculous dacryocystitis. Two patients had eyeball involvement; one was tuberculous necrotizing scleritis, another one had tubercular vasculitis retinae. Out of four three had unilateral involvement. Three of them respond well to anti TB & anti inflammatory therapies; one respond to anti TB therapy only. Conclusions: Tuberculosis can affect any structure of eye and adnexae.The diagnosis is difficult because of diversity of presentation and most of the time there is absent of concurrent systemic infection. Early diagnosis and treatment can prevent blindness or severe ocular morbidity. In cases of non healing lesion and atypical inflammatory presentation, we stress the need for a high index of suspicion regarding tuberculosis.