Introduction: Tuberculosis of the eye represents a challenge all over the world, and there is a continuous debate about its pathophysiology, methods of diagnosis, and drugs used in treatment .
Study design: Interventional prospective study.
Objective: To focus on the variable clinical presentations, and on the diagnostic and therapeutic characteristics of ocular tuberculosis.
Method: fifteen eyes from nine cases with ocular tuberculosis were diagnosed, treated and followed up between 2010 and 2020, diagnosis was based on a compatible clinical picture, highly positive TST (Tuberculin skin test) or IGRA test (interferon- gamma release assay), and a dramatic response to anti-tuberculous drugs alone without systemic steroid.
Results: Mean age of the patients was 41.22±13.64 years, eight out of the nine cases were females (89.8%), one male patient(11.1%). Only one case had pulmonary tuberculosis, the other 8 cases had clear lungs. Bilateral ocular involvement was in two third of cases (66.7%) ( 6 out of 9 patients) and the most common clinical presentation was intermediate uveitis (33.3%) (5 eyes out of 15), the second most common presentation was multifocal choroiditis (20%) (3 eyes out of 15), all the cases had favorable outcome, i.e. cured without relapse for the 2-10 years of fellow up period, after taking oral anti-tuberculous drugs for 6-9 months, except one case, the case of panophthalmitis, which cured but ended with perforation and phthiasis. No systemic steroids were given, only topical steroid drops given as indicated .
Conclusion: Ocular tuberculosis is a very serious and mysterious condition with a very wide range of clinical presentations, bilaterality is very common, but usually there is significant asymmetry in severity between the two eyes, and involvement of the other eye may take months to years, therefore it should be considered in the differential diagnoses of any type of intraocular inflammation, or any unexplained reduction in vision. Oral anti-tuberculous drugs with or without topical steroids are sufficient to improve vision, produce cure and prevent relapse.
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