Ocular tuberculosis masquerading as ocular tumors

Tuberculosis has re-emerged as a serious public health problem in recent years. The ocular manifestations of tuberculosis are uncommon and diverse. Occasionally, patients initially present with ocular symptoms that simulate intraocular malignancy or other inflammatory conditions. We present five patients with ocular tuberculosis who were referred with the suspicion of ocular malignancy. Four of the five patients had recently emigrated to the United States. The presenting features of these patients were panophthalmitis (one patient), endophthalmitis leading to scleral perforation (one patient), active choroidal granuloma associated with uveitis (two patients), and amelanotic choroidal lesion without inflammatory signs (one patient). Of these five cases, two had a known history of systemic tuberculosis, while the ocular findings in the other three cases were the presenting manifestation of systemic tuberculosis. Multi-drug antituberculous regimen were employed in all cases for a mean of 9 months (median 6 months, range 6-12 months). Three patients responded well to therapy with salvage of the globe and the two remaining patients underwent primary enucleation for blind painful eye or perforated eye. In conclusion, ocular tuberculosis can have variable clinical manifestations and occasionally appears as an intraocular or epibulbar tumor. A high degree of clinical suspicion is important, especially in immigrants from developing countries.