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Presumed ocular tuberculosis – need for caution before considering anti-tubercular therapy

Eye volume 37, pages 3716–3717 (2023)Cite this article

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However, conditions such as syphilis, sarcoidosis and autoimmune disorders may be associated with similar presentations of uveitis [2]. Majority of these cases may just be an idiopathic ocular pathology. Thus, it would be inappropriate to ascribe these phenotypes of uveitis to tuberculosis in the absence of definite systemic evidence of tuberculosis.

Some recent studies suggest TB as the aetiology of isolated retinal vasculitis and serpiginous like choroiditis in the absence of systemic evidence of TB, based on tests for latent TB such as Tuberculin Skin Test (TST)/Interferon Gamma Release Assays (IGRA) and detection of tubercular DNA from ocular fluids [3, 4]. An undue emphasis has been laid on TST /IGRA as evidence of TB disease, while these tests are only a marker of Latent Tuberculosis infection (LTBI). Few studies suggest clinical signs to differentiate idiopathic form of vasculitis/serpiginous like choroiditis from the tubercular variety [3, 5]. In the Collaborative Ocular Tuberculosis Study, the authors recommend starting ATT even if only TST or IGRA is positive [6]. In India, with a high endemicity of TB, LTBI is reported in 31.4% population [7] and thus the validity of this recommendation needs to be critically addressed. WHO clearly mandates against the use of tests for LTBI for diagnosis of tuberculosis [8]. Detection of TB DNA needs careful interpretation in the absence of clinical signs and symptoms [9, 10].

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Fig. 1: Fundus photographs of definite and presumed ocular tuberculosis.

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Authors and Affiliations

  1. Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

    Rohan Chawla, Devesh Kumawat & Pradeep Venkatesh

  2. Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India

    Urvashi B. Singh

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  1. Rohan Chawla
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  4. Pradeep Venkatesh
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RC, UBS, DV and PV all contributed in conceptualizing, critically analysing existing data on the subject, writing and editing the manuscript.

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Correspondence to Rohan Chawla.

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Chawla, R., Singh, U.B., Kumawat, D. et al. Presumed ocular tuberculosis – need for caution before considering anti-tubercular therapy. Eye 37, 3716–3717 (2023). https://doi.org/10.1038/s41433-023-02628-3

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