This document discusses tubercular uveitis, which occurs in 1-2% of patients with tuberculosis. Tubercular uveitis can involve both the anterior and posterior segments of the eye. Common manifestations include granulomatous iritis, interstitial keratitis, phlyctenular keratoconjunctivitis, choroidal granulomas, posterior uveitis, and retinal vasculitis. Diagnosis is difficult as obtaining ocular tissue samples is hard to justify, but a positive PPD test, interferon-γ release assay, or Quantiferon-TB Gold test provides supporting evidence. Treatment involves a combination of antibiotics like isoniazid and rifampin over several months along

1. TUBERCULAR UVEITIS
Bipin Bista
Resident
Ophthalmology
National medical College
& Teaching Hospital

2. HISTORY
 Guyton & Woods (1940) identified as the vast majority of patients
with granulomatous uveitis.

3. SYSTEMIC DISEASE
 Transmitted predominately in aerosolised droplets.
 Most of them are asymptomatic, self-limited pneumonia which
heals with granuloma formation.
 Sensitization develops after 2-10 weeks of infection & manifested
by positive skin test extract of tuberculous bacilli.
 Granuloma usually calcifies & becomes inactive.
 However, onset of symptoms after breakdown of immune system.

4. OCULAR DISEASE
 Occurs in 1-2 % of patient with Tuberculosis.
 Involves both anterior as well as posterior segment. Anterior segment
also includes ocular adnexa & orbit.
 In miliary tuberculosis, there will be involvement in choroid making an
impression of unifocal/multifocal choroiditis, and in some serpiginous
choroiditis.
 Tubercles associated with development of subretinal
neovascularization.

5. MANIFESTATION
 Most commonly Granulomatous iritis.
 Suspect tubercular uveitis in granulomatous as well as non-
granulomatous
 Interstitial keratitis & phlyctenular keratoconjunctivis are usually
common – not by direct invasion but an immunological response to
mycobacterium.
 Eales disease
 Optic nerve involvement & cataract are also seen.

6. CHOROID TUBERCLE

7.  Tubercle formation of eyelids
 Conjunctivitis
 Interstial keratitis
 Anterior uveitis
 Scleritis
 Choroidal granulomas
 Posterior uveitis
 Retinal vasculitis
OCULAR MANIFESTATION

8. DIAGNOSIS
 Identification of M.tuberculosis
 Ocular tissues or fluids.
 Samples are difficult to obtain & biopsy are hard to justify.
 Positive PPD Test : Intermediate strength PPD test : shows a severe
dermatological response- not 100% sensitive or specific.
 Interferon-γ- release
 Quantiferon – TB Gold .

9. THERAPY
 Previously, Isoniazid & ethambutol for 1.5 to 2 years.
 Late 1960’s, short-couse regimen – Isoniazid & rifampicin for 9
months.
 Addition of 3rd Drug – Ethambutol, Streptomyci n or
Pyrizinamide – added for first 3 months.
 2 months : Isoniazid, rifampin, pyrizinamide & ethambutol.
 4 months : Isoniazid & rifampin

10.  Schlaegal & Weber (1969) : Isoniazid Therapeutic Test :
300mg/day, examining every week. If inflammation improves , then
full course therapy.
 Concomitantly treated with corticosteroids : to prevent recurrence.
 Chest X-ray : hematogenous seeding of organisms from lung.
 History of TB exposure, Inadequately treated TB, Positive PPD
test.

11. Reference:
- Nussenblatt and whitecup
4th edition
- Myron yanoff 4th edition