Presumed Ocular Tuberculosis – Challenges in Diagnosis

Abstract

Mycobacterium tuberculosis has a large spectrum of extra-pulmonary manifestations, and ocular tuberculosis is one of them. Diagnosis of ocular tuberculosis is often presumptive due to its extreme variability of ocular manifestations and difficulty isolating the organism through biopsy or culture. We report three cases of primary ocular tuberculosis with varied clinical presentations, namely neuroretintis, panuveitis, and occlusive vasculitis. Patients were aged 23 to 45 presented with symptoms of blurring of vision from 3 days to one week prior to presentation. Visual acuity ranged from 6/18 to 2/60. For all three cases, chest X-ray and serological investigation for infective causes were normal. Mantoux test and TB Quantiferon test were negative, and ESR was raised for the first two cases. Mantoux was positive, and ESR was not raised for the third case. Patients were diagnosed to have Presumed Ocular Tuberculosis. An anti-tubercular therapy was administered. There was significant improvement at post-initiation of medication. A high index of clinical suspicion is crucial due to the diverse clinical presentations of ocular tuberculosis. Early initiation of anti-tubercular therapy is vital for successful treatment.