Current clinical management of ocular tuberculosis

ABSTRACT

Introduction: Management of ocular tuberculosis (OTB) poses a significant challenge due to heterogenous clinical presentations and persistent gaps in detection and treatment. The role of antitubercular therapy (ATT) still remains controversial, without international agreement regarding initiation and duration of ATT and concurrent use of systemic corticosteroids.

Areas covered: This review serves the purpose of quick reference for ophthalmologists, providing guidance regarding the treatment of OTB in collaboration with pulmonologists and infectious disease specialists.

Expert opinion: A large-scale international study is required to reach meaningful conclusions that will define the relevance of phenotypes, results of tests, and response to therapy. Only by pooling together resources, knowledge, experience, and data, can the understanding of OTB be improved.

KEYWORDS:

• Ocular tuberculosis
• tubercular uveitis
• clinical management
• antitubercular therapy
• corticosteroids

Article Highlights

• Diagnosis and management of ocular tuberculosis (OTB) still represent a significant challenge due to lack of diagnostic criteria and gold standard tests.

• Two possible pathophysiological mechanisms, involving active mycobacterial infection and immunological response, have been hypothesized. 


• There is no international agreement regarding treatment regimen for OTB.

• Anti-tubercular therapy (ATT) includes a four-drug regimen with isoniazid, rifampicin, ethambutol, and pyrazinamide for at least 2 months, followed by a two-drug therapy with isoniazid and rifampicin for at least 4 months.

• Current literature reflects efficacy of ATT in the treatment of OTB.

• Systemic corticosteroids and local immunosuppression are often used in combination with ATT to control TB-related intraocular inflammation.

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This work was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.