Tuberculous uveitis, a resurgent and underdiagnosed disease

Over the last decade ocular involvement due to tuberculosis has re-emerged. In non-endemic areas the low frequency of active tuberculosis is at the origin of an underestimation of the disease. The purpose of this study is to report a group of patients with presumed tuberculous uveitis and to analyse the pre-diagnostic course, the diagnostic delay and the evolution of ocular inflammation after diagnosis and anti-tuberculous treatment.

Criteria for presumed tuberculous uveitis included the presence of a hyperpositive tuberculin skin test with compatible uveitis and the exclusion of other possible etiologies.

Thirty-five patients fulfilled the diagnostic criteria for presumed tuberculous uveitis and were included in the study. The diagnosis was performed at presentation in only seven patients, while the correct diagnosis was delayed in the other 30 patients. The mean diagnostic delay was 5.7 +/- 4 years. Anti-tuberculous therapy was given for a minimum of 6 to a maximum of 24 months. Post-diagnostic mean follow-up was 30.4 +/- 13.4 months. Anti-tuberculous therapy resulted in a highly significant increase in visual acuity, from 0.53 to 0.78 (P < 0.001), a highly significant decrease of recurrences, from 100 to 10% (P < 0.001), with only three recurrences observed during the follow-up, and a highly significant decrease in intra-ocular pressure, from 18.3 to 13.7 (P < 0.001).

Our study tends to confirm the existence of tuberculous uveitis and supports the validity of the proposed diagnostic criteria. Recognition of the correct diagnosis and specific therapy, even with substantial delay, avoids recurrences, improves visual acuity and intra-ocular inflammation and decreases intra-ocular pressure.