Even though one-third of the world’s population has been exposed to Mycobacterium tuberculosis, active M tuberculosis uveitis is uncommon, even in endemic areas. Suggestive clinical findings include solitary (Fig 11-19) or multifocal choroiditis, serpiginous-like chorioretinitis, and Eales disease–like peripheral nonperfusion in association with uveitis. Patients suspected of having tuberculous uveitis should undergo testing for prior M tuberculosis exposure, including a chest X-ray and either purified protein derivative (PPD) skin testing or a blood-based interferon-gamma release assay.
Figure 11-19 Ocular tuberculosis. Color fundus photograph shows a choroidal granuloma superotemporal to the optic nerve head.
(Courtesy of Janet L. Davis, MD.)
Once the diagnosis of ocular tuberculosis is either confirmed or strongly suggested, the patient should be treated for extrapulmonary tuberculosis as recommended by either the US Centers for Disease Control and Prevention or the World Health Organization.
Abouammoh M, Abu El-Asrar AM. Imaging in the diagnosis and management of ocular tuberculosis. Int Ophthalmol Clin. 2012;52(4):97–112.
Gupta A, Bansal R, Gupta V, Sharma A, Bambery P. Ocular signs predictive of tubercular uveitis. Am J Ophthalmol. 2010;149(4):562–570.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.