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Aim: To evaluate the role of combined Mantoux test and serum angiotensin-converting enzyme (ACE) levels in the diagnosis of ocular tuberculosis (TB) and ocular sarcoidosis. Materials and Methods: A prospective and observational study including patients with bilateral granulomatous uveitis diagnosed both radiologically and clinically as ocular TB or ocular sarcoidosis within a six-month period. CT Thorax/CT abdomen was done, and findings were noted. Mantoux test and serum ACE levels were recorded, and findings were correlated. Results: The study included a total of 60 patients: 32 patients with ocular TB and 28 patients with ocular sarcoidosis. Using Mantoux test, 84.4% in the TB group tested positive and were correctly identified (sensitivity), and 96.4% in the sarcoid group tested negative and were correctly identified as sarcoidosis. Hence, the association between Mantoux test and diagnoses was statistically significant (P < 0.001). In the TB group, 25 subjects had normal and seven had elevated serum ACE levels. In the sarcoidosis group, 22 subjects had elevated and six had normal serum ACE levels. Hence, 78.1% were correctly identified with normal serum ACE levels (sensitivity) in the TB group and 78.6% were identified with elevated serum ACE levels in the sarcoidosis group, and the proportion difference was statistically significant (P < 0.001). Conclusion: Mantoux test and serum ACE levels are cost-effective investigations and can be used for the diagnosis of ocular TB and sarcoidosis when combined with clinical and radiological evidence. The combined use of serum ACE and Mantoux test is useful in differentiating between sarcoidosis and TB.

Context: The diagnosis and management of ocular tuberculosis (OTB) is largely a mystery, and the fact that it is a great imitator of various ocular pathologies adds to the difficulty in the diagnosis of patients. Aims: The aim of this study was to assess the role of the Mantoux test in the diagnosis of OTB. Settings and Design: This was a retrospective chart review of patients who were diagnosed to have and treated as OTB in 1 year at our tertiary care center in Western India. Methods: The study population included 34 patients who presented to us and were diagnosed to have OTB, using standards published by the Department of Health Research, Ministry of Health and Family Welfare, Government of India, and the Indian Council of Medical Research. Results: A total of 34 patients were diagnosed to have OTB in the study period of 1 year between January 1, 2021, and December 31, 2021. Of these 34 patients; 14 were male and 20 were female. The Mantoux test had been done in 32/34 patients. It was positive in 26 patients and negative in six patients. Looking specifically at the six patients in whom the Mantoux was negative, apart from having ocular signs of tuberculosis (TB), they had positive findings suggestive of old/active TB on contrast-enhanced chest computed tomography scan. Of the 34 patients, only five patients were treated based only on the clinical signs of OTB with only a positive Mantoux test, but even they all showed a response to treatment. Conclusions: There is a definite role of the Mantoux test when interpreted considering the clinical phenotype and radiology findings in OTB.

Background: The human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) is a multi-systemic disease with known manifestations involving all ocular structures from the orbit and ocular adnexa, anterior segment to the retina and vitreous. Some of these manifestations including cytomegalovirus (CMV) retinitis and HIV retinopathy are HIV/AIDS-defining illnesses. The aim of this study is to determine the vitreoretinal manifestations in patients with HIV/AIDS attending an antiretroviral therapy clinic in Nigeria. Methods: This was a prospective, cross-sectional study of consenting, confirmed HIV/AIDS patients attending an antiretroviral therapy clinic in Nigeria. All willing, consecutive patients who gave an informed consent were recruited. Sociodemographic data and clinical information were collected with the use of a structured interviewer–administered questionnaire. Best-corrected visual acuity was recorded. Anterior segment and ocular adnexa examination was performed with a pen torch. Detailed anterior and posterior segment examination was performed with slit lamp biomicroscopy with Volks +78 diopter lens and binocular indirect ophthalmoscopy. The data were analyzed with SPSS (statistical package for social sciences) version 16. Ethical approval was obtained from the institutional ethics committee. Results: Three hundred and eighteen patients were studied of which 85 (26.7%) had disorders affecting the retina and vitreous. The female-to-male ratio was 2:1. More than a third of patients (38.7%) were in the 40–49 years of age group and the mean age was 47.2 years. The most common vitreoretinal lesion was presumed ocular toxoplasmosis present in 9.7% of all respondents. This was closely followed by HIV retinopathy in 3.5%, ocular tuberculosis in 1.8%, and CMV retinitis in 1.6% respondents. Two hundred and seventy-seven (87.1%) respondents were on highly active antiretroviral therapy and 41 (12.9%) were not on treatment. Conclusion: A high prevalence of ocular conditions especially those affecting the retina and vitreous exists in patients with HIV/AIDS attending the antiretroviral therapy clinic in a tertiary hospital in Nigeria. Regular eye examinations are recommended for these patients to prevent potentially visual debilitating disorders.

This case report represents an unusual presentation of ocular tuberculosis (TB). Ocular TB is rare, but it can be the first clinical manifestation of the disease. Here, we report a case of a 67-year-old male, a chronic smoker who presented with pain, redness, and photophobia (BE), and slit-lamp examination showed multiple corneal infiltrate along the limbus with multiple scleral abscesses not responding to routine treatment. Investigations revealed high erythrocyte sedimentation rate value, positive Mantoux reaction, and changes on contrast-enhanced computed tomography of the thorax. Sputum CBNAAT was negative, and pus aspirate revealed no growth with negative staining for acid-fast bacillus. With high suspicion of TB, we started on Anti tuberculosis therapy, and there was rapid healing of lesions. In endemic areas, even when microbiological studies are not positive, ocular TB should be kept in mind in atypical cases so that early treatment can be instituted to prevent serious complications.

Polymerase chain reaction (PCR) is a revolutionary innovation involving enzymatic amplification of nucleic acid sequences in repeated cycles of denaturation, oligonucleotide annealing, and DNA polymerase extension. It is a unique molecular biologic tool that allows the rapid production of analytic quantities of DNA from small amounts of starting material. PCR can be performed on any ocular specimen or biopsy. The most common application of the PCR is human leukocyte antigen (HLA) typing. A universal bacterial PCR can be very helpful for the diagnosis of bacterial endophthalmitis at an early stage of the disease. There are also several advances in the application of PCR in the recent time, and this technology has opened a new era in the diagnosis and treatment of uveitis, enabling ophthalmologists to establish new clinical entities of uveitis caused by infectious microorganisms, identify pathogens in the eyes of many patients with uveitis, and determine prompt diagnosis and appropriate therapy.

Ocular tuberculosis (OTB) is the first cause of ocular inflammation of infectious origin in developing countries. It can affect all structures of the eye without pathognomonic presentation. Its diagnosis remains challenging owing to the difficulty of sampling for histopathological and microbiological investigations. A 36-year-old male patient with no previous medical history was admitted for a scleral mass in his right eye, which was diagnosed elsewhere 45 days before. On examination, a minimal intraocular inflammatory reaction and right eyelid swelling were noted. A scleral lesion in the superior nasal quadrant of the right eye was observed and was responsible for globe displacement inferolaterally and for restricted eye motility. An excision biopsy of the suspicious lesion was made. Histological examination revealed a tuberculous granuloma associated with caseous necrosis. Sputum smear result was negative for Mycobacterium tuberculosis. Further investigations excluded extra-OTB involvement. The patient received 6 months of antitubercular therapy. The disease evolution was favorable. The authors also reviewed all reported cases of histologically confirmed OTB in the literature by search in PubMed till December 2019. Cases with histopathology results revealing granulomatous inflammation without caseous necrosis and cases of tubercular dacryoadenitis were excluded from the search, at enrollment.

Diagnosis and management of ocular tuberculosis (OTB) poses a significant challenge. Mixed ocular tissue involvement and lack of agreement on best practice diagnostic tests together with the global variations in therapeutic management contributed to the existing uncertainties regarding the outcome of the disease. The current review aims to update recent progress on OTB. In particular, the Collaborative Ocular Tuberculosis Study (COTS) group recently standardized a nomenclature system for defining clinical phenotypes, and also proposed consensus guidelines and an algorithmic approach for management of different clinical phenotypes of OTB. Recent developments in experimental research and innovations in molecular diagnostics and imaging technology have provided a new understanding in the pathogenesis and natural history of the disease.

Ocular neoplasia can masquerade as an inflammatory condition and vice-versa, which if untreated, can lead to loss of vision or even life. We present a young immunocompetent adult male referred to us as choroidal melanoma. He had a large atypical choroidal mass and exudative retinal detachment. He had no systemic complaints and ocular lesions were the first manifestation of disseminated disease. Aqueous polymerase chain reaction for Mycobacterium tuberculosis (MTB) was negative, but Mantoux, chest radiology, acid-fast bacilli, and caseation necrosis on pleural nodule histopathology confirmed tuberculosis (TB). While on antitubercular therapy, a rare “Coats'-like response” was noted which eventually resolved completely with treatment.

Purpose: To analyze the outcome of cataract surgery in patients with ocular tuberculosis (OTB). Methods: Medical records of patients with OTB who underwent cataract surgery between 2005 and 2018 were retrospectively reviewed. The primary outcome measure was corrected distant visual acuity (CDVA), and a good outcome was defined as CDVA 20/40 or better. Results: There were 35 patients (41 eyes), of whom 13 (37.1%) were males and 22 (62.9%) were females. The mean age was 41.6 ± 13.8 (range 18–65) years. Anterior uveitis was present in 24 (58.5%) eyes, intermediate uveitis in 5 (12.2%) eyes, posterior uveitis in 6 (14.6%) eyes, and panuveitis in 6 (14.6%) eyes. Posterior sub-capsular cataract (51.2%) was the most common type of cataract. Total cataract was present in 9 (22%) eyes. The two most common ocular comorbidities were small pupil (85.4%) and glaucoma (17.1%). Phacoemulsification was performed in 36 (87.8%) eyes and ECCE was performed in 5 (12.2%) eyes. Intraoperatively the pupil was mechanically dilated in 36 (87.8%) eyes. Overall 26 (63.4%) and 23 (56.1%) eyes achieved CDVA 20/40 or better at 1- and 6-month follow-up visit, respectively. The mean preoperative LogMAR CDVA significantly improved from 1.28 ± 0.57 to 0.38 ± 0.36 at 1-month (P < 0.0001). One eye had fibrinous anterior chamber reaction and 24 (58.5%) eyes had 1 or more episodes of reactivation of uveitis in the follow-up period. The three commonest complications were glaucoma (26.8%), posterior capsule opacification (19.5%), and epiretinal membrane (17.1%). Postoperative posterior segment complications like epiretinal membrane formation, vitreous inflammation and cystoid macular edema affected final visual acuity (P < 0.002). Conclusion: The visual outcome after cataract surgery in OTB was satisfactory as significant number of patients achieved a good final visual acuity.

This case report represents an unusual presentation of Mycobacterium tuberculosis-associated corneal ulcer with hypopyon. A 64-year-old man presented with a hypopyon corneal ulcer in the right eye. His corneal scrapings were negative, and the ulcer was not responding to empirical antimicrobial therapy. A real-time polymerase chain reaction from an aqueous aspirate of the right eye detected 422 copies of M. tuberculosis. Subsequent investigations revealed positive Mantoux and interferon-gamma release assay, supportive radiology. The patient was successfully treated with a course of antitubercular therapy and topical steroids. Hypopyon corneal ulcer, though a rare manifestation of ocular tuberculosis, should be considered in cases not responding to standard antimicrobial therapy.

We describe a case of right eye tubercular (TB) panuveitis with corneal involvement where repeated intraocular sampling was unsuccessful. Finally, evisceration and histopathology of ocular tissue confirmed the diagnosis of ocular tuberculosis. A chest X-ray showed signs of pulmonary TB. The patient was lost to follow-up but reported 2 months later with the right eyelid margin nodules with surface ulceration. Both eyelid and pulmonary lesions were resolved with anti-TB therapy.

A 31-year-old male patient presented with sudden onset loss of vision in the left eye. Ocular examination revealed significant vitritis with chorioretinitis lesion in the posterior pole. Subsequent investigations revealed positive human immunodeficiency virus (HIV) and syphilis serology; chest imaging revealed active pulmonary tuberculosis. Polymerase chain reaction from aqueous aspirate was positive for Mycobacterium tuberculosis. There was complete resolution of the lesions following antisyphilitic medications, antitubercular therapy along with highly active antiretroviral therapy. Syphilis and tuberculosis coinfection in a previously unknown HIV patient is rare but can occur. It is worthwhile to look for multiple coinfections in HIV patients.

Ocular tuberculosis (OTB) in patients with human immunodeficiency virus (HIV) commonly presents as choroidal tubercles or granuloma. We report a rare presentation of OTB with hypopyon granulomatous uveitis in a patient with HIV on highly active antiretroviral therapy (HAART). Aqueous humor polymerase chain reaction (PCR) was positive for Mycobacterium tuberculosis (MTB). Antitubercular therapy (ATT) was initiated despite which it progressed to scleral abscess and panophthalmitis. Enucleation with ball implantation was done. Histopathology revealed caseating granuloma with numerous acid-fast bacilli (AFB) and real-time PCR showed increased copies of MTB genome. After a full course of ATT, he had stable ocular and systemic condition at final follow-up.

Background Tuberculosis (TB) is considered a multisystemic disease showing many extrapulmonary presentations. TB uveitis is one of the common forms of extrapulmonary TB. The lung is still the first organ to be attacked by TB, and pulmonary TB is the only infectious form of the disease. Aim The aim of the study was to detect the prevalence of active pulmonary TB among patients with TB uveitis. Patients and methods The present study included 37 patients with diagnosis of ocular TB on the basis of previous history, ocular examination, and exclusion of other suspected causes of uveitis. In addition, positive tuberculin skin test, or positive interferon-gamma release assays were carried out. All included patients were subjected to sputum examination for acid-fast bacilli and plain radiography of chest P-A view, and certain cases had a bronchoalveolar lavage. Patients with active pulmonary TB were detected. Both groups (patients with active pulmonary TB and patients with free chest) were compared with regard to all the previously mentioned studied parameters. Results The mean age of the studied patients was 34.8±12.5 years. All the studied patients showed positive tuberculin test with a mean of 18.5±3.4 mm. With regard to the Quantiferon Gold test, 34 patients (91.9%) had positive results. Concerning radiography, only 10 (27%) patients had normal radiograph, the rest of the patients showed various radiological lesions. Thirty (81.1%) patients were diagnosed to have active pulmonary TB. Sputum examination for acid-fast bacilli revealed that 22 (59.5%) patients had positive results; an additional eight patients (who had negative results on sputum examination) showed positive results when they underwent a bronchoalveolar lavage. There was no statistically significant difference with regard to all the previously mentioned parameters between patients with active pulmonary TB and patients with a free chest. Conclusion The present study revealed that a considerable percentage of the patients with TB uveitis had active pulmonary TB.

Choroidal tuberculoma is a solitary elevated choroidal mass-like lesion regarded often characteristic of intraocular tuberculosis. Serial swept-source optical coherence tomography (SS-OCT) is a very important tool in monitoring the course of choroidal tuberculoma and allows in early detection of complications such as choroidal neovascular membrane (CNVM). We describe a 26-year-old young Indian female, who presented with a solitary choroidal mass lesion in the left eye. Based on positive Mantoux test, biopsy of cervical lymph nodes showing acid-fast bacilli and radiographic findings, a diagnosis of choroidal tuberculoma was made. Serial SS-OCT during subsequent follow-up visits up to 14 months demonstrated the characterization of the lesion and assessment of response to antitubercular therapy and oral steroid. The patient was subsequently diagnosed to have concurrent CNVM and successfully treated with two anti-vascular endothelial growth factor intravitreal injections.

Tuberculous optic neuropathy that includes papillitis, neuroretinitis, and optic nerve tubercle is a rare presentation of ocular tuberculosis. Though contagious spread from choroid following the hematogenous dissemination of the bacilli has been implicated in the optic nerve involvement, unlike neuroretinitis, optic nerve and choroidal involvement are usually considered as two separate clinical entities. We report a case of optic nerve involvement in a 33-year-old male who had concurrent choroidal involvement at present and also in the past. A strong history of contact with patients of pulmonary tuberculosis, positive tuberculin skin test, interferon gamma release assay, and high-resolution computed tomography helped us to clinch the diagnosis. Patients responded to systemic corticosteroid therapy and anti-tuberculosis treatment. Choroidal involvement in a case of inflammatory optic neuropathy should arise suspicion of tuberculous etiology.

Blau syndrome (BS) is a rare autoinflammatory disorder characterized by the clinical triad of arthritis, uveitis, and dermatitis due to heterozygous gain-of-function mutations in the NOD2 gene. BS can mimic juvenile idiopathic arthritis (JIA)-associated uveitis, rheumatoid arthritis, and ocular tuberculosis. We report a family comprising a mother and her two children, all presenting with uveitis and arthritis. A NOD2 mutation was confirmed in all the three patients – the first such molecularly proven case report of familial BS from India.

Purpose: To report the case of a patient with persistent vitreous hemorrhage in the right eye (RE) caused by occlusive retinal vasculitis secondary to tuberculosis. Methods: Male patient, 35 years old, with Indian ancestry, no history of previous systemic illness. First presented to our outpatient clinic with decreased visual acuity in the RE, lasting eight months. On exam, best-corrected visual acuity (BCVA) RE was

Any organ system in the body can be affected by tuberculosis (TB). While pulmonary TB is the most common presentation, extrapulmonary TB including ocular TB is also an important clinical problem. Most commonly, ocular TB presents as anterior uveitis or choroiditis, which is caused either by hematogenous infection or hypersensitivity after another organ infection. Eyelid involvement by TB is mostly secondary to orbital TB and often presents as a draining sinus. Isolated eyelid TB is, however, uncommon. We present the case of a 6-year-old girl with eyelid TB presenting as chronic nonhealing skin ulcer.

The purpose of this article is to present a rare manifestation of ocular tuberculosis (TB). Here, we present a case of a 19-year-old female who came to our department with defective vision in the left eye (LE) for 20 days which was insidious in onset and progressive in nature. The visual acuity in the affected eye was 2/60. Anterior segment examination of both eyes was normal. Fundus examination of LE showed active papillitis with macular edema. Fundus fluorescein angiography showed optic nerve hyperfluorescence with leakage and macular edema in the LE. All other investigations were found to be within normal limits except QuantiFERON-TB Gold and Mantoux which showed an induration of 19 mm. The patient was presumed to be a case of TB of optic nerve head and started on antituberculous therapy. She showed a rapid response to the treatment and her visual acuity improved to 6/9 at the end of 2 months.

Human papillomavirus (HPV) infection is strongly associated with several human cancers; the most known genotypes involved being HPV 16 and HPV 18. We report the detection of HPV 52 in a sample taken from a 47-year-old patient with squamous cell carcinoma of the conjunctiva of the left eye. The method used for the detection of HPV was real time polymerase chain reaction. The evolution was favorable after surgical removal of the tumor and the patient was explained that long-term follow-up is essential to avoid recurrence.

Uveitis and erythema induratum are two uncommon extrapulmonary manifestations of tuberculosis (TB). In most circumstances, we cannot isolate mycobacterium from those sites, so diagnosis is difficult. In the presented case, panuveitis, erythema induratum, and persistent anogenital warts were found concurrently in a 19-year-old girl who had a history of pulmonary TB 10 years ago. Assessment of her immune condition ruled out any immunodeficiency state. Extrapulmonary TB and persistent warts responded dramatically to anti-TB drugs and interferon-gamma, respectively. Our case reveals that a constellation of these clinical manifestations may also occur in immunocompetent individuals.

We report a case of ocular tuberculosis (TB) which initially presented with disc edema and was mistaken for optic neuritis. With no definite pathology being identified, the patient was treated on the lines of optic neuritis with intravenous (IV) steroid with beneficial effect. Ocular TB was suspected when he presented later with a subretinal abscess. Based on positive Mantoux, QuantiFERON TB gold results and radiographic findings, a diagnosis of subretinal abscess of presumed tubercular etiology was made. The patient was successfully treated with anti-tubercular therapy. To the best of our knowledge, this is the first case report of ocular TB presenting as disc edema followed by subretinal abscess.

Posterior uveitic entities are varied entities that are infective or non-infective in etiology. They can affect the adjacent structures such as the retina, vitreous, optic nerve head and retinal blood vessels. Thorough clinical evaluation gives a clue to the diagnosis while ancillary investigations and laboratory tests assist in confirming the diagnosis. Newer evolving techniques in the investigations and management have increased the diagnostic yield. In case of diagnostic dilemma, intraocular fluid evaluation for polymerase chain testing for the genome and antibody testing against the causative agent provide greater diagnostic ability.

With an expanding awareness of ocular tuberculosis, ophthalmologists are increasingly required to participate in the care of these patients. We conducted a survey of published ophthalmic literature to identify whether the regimens of antitubercular medications prescribed conform to current guidelines. A Medline search for publications (1995-2005) was done and the data were systematically analyzed with respect to demographic features, clinical findings and the antitubercular therapy prescribed. Of the 34 papers (82 patients) available, 33 papers described the prescribed antitubercular therapy. Eighteen papers (54.5%, 46 patients) conformed to guidelines versus 15 papers (45.4%, 32 patients) did not, suggesting that a large proportion of papers do not conform to current guidelines. Wider dissemination of therapeutic guidelines is necessary to encourage rational therapy and minimize therapeutic failures, drug resistance or relapse.