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The International Journal on Orbital Disorders, Oculoplastic and Lacrimal Surgery
Volume 27, 2008 - Issue 4
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ORIGINAL ARTICLE

Orbital Tuberculosis: A Review of the Literature

, MRCP, FRCOphth, , MS, MRCOphth, , MD, FRCS, , MD, , MD, FACS & , FRACS, FRANZCO
Pages 267-277 | Received 10 Dec 2007, Accepted 28 Feb 2008, Published online: 08 Jul 2009
 

Abstract

Purpose: To provide an up-to-date review of the clinical presentations, investigations, and management of orbital tuberculosis (OTB). Methods: Systematic review of the literature concerning OTB, limiting the results to English-language peer-reviewed journals. Results: Seventy-nine patients from 39 publications were identified as cases of OTB. The condition presents in one of five forms: classical periostitis; orbital soft tissue tuberculoma or cold abscess, with no bony involvement; OTB with bony involvement; spread from the paranasal sinuses; and tuberculous dacryoadenitis. The ocular adnexa, including the nasolacrimal system and overlying skin, may also be involved. Conclusions: Diagnosis can be difficult and may necessitate an orbital biopsy, in which acid-fast bacilli (AFB) and characteristic histopathology may be seen. Growth of Mycobacterium tuberculosis (mTB) from such a specimen remains the gold standard for diagnosis. Ancillary investigations include tuberculin skin tests and chest radiography, but more recently alternatives such as whole blood interferon-γ immunological tests and PCR-based tests of pathological specimens have proven useful. The management of OTB is complex, requiring a stringent public health strategy and high levels of patient adherence, combined with long courses of multiple anti-tuberculous medications. The interaction of the human immunodeficiency virus (HIV) with TB may further complicate management.

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