Bilateral Atypical Optic Neuritis With Posterior Scleritis Secondary to Tuberculosis: Challenges in Management

Area of Science:

• Ophthalmology
• Infectious Diseases
• Neurology

Background:

• Extrapulmonary tuberculosis (TB), caused by Mycobacterium tuberculosis, can manifest with ocular complications.
• Atypical optic neuritis and posterior scleritis are rare but serious ocular signs of TB.

Observation:

• A 36-year-old male presented with bilateral blurred vision, eye pain, cough, and weight loss.
• Ophthalmic examination revealed decreased visual acuity, afferent pupillary defect, and bilateral optic disc swelling.
• Orbital MRI confirmed optic nerve enhancement and posterior scleritis.

Findings:

• The patient was diagnosed with bilateral atypical optic neuritis and posterior scleritis secondary to pulmonary TB.
• Initial antitubercular treatment and high-dose corticosteroids led to a deterioration of vision.
• Despite treatment modifications, vision remained poor at discharge, highlighting the severity of the condition.

Implications:

• Atypical optic neuritis and posterior scleritis can present concurrently, leading to sight-threatening outcomes.
• Prompt diagnosis and integrated management of tuberculosis are essential for preserving vision and preventing long-term ocular damage.
• This case underscores the importance of considering TB in patients with unexplained optic nerve and scleral inflammation.