Ocular Involvement in Disseminated Tuberculosis: A Case of Neuro-Retinitis

Neuro-retinitis is a rare ocular manifestation of disseminated tuberculosis (TB), often presenting with optic disc swelling and a macular star. Early diagnosis is essential to prevent permanent visual impairment, especially in TB-endemic areas where such presentations may be overlooked.

We report a case of a 38-year-old male who presented with a 2-week history of progressive, painless vision loss in the left eye. Fundoscopy revealed optic disc swelling and a macular star, suggestive of neuro-retinitis. Systemic evaluation, including chest imaging and immunologic testing, confirmed disseminated TB. Other potential infectious and autoimmune causes were excluded. The patient was initiated on standard anti-TB therapy (isoniazid, rifampicin, pyrazinamide, and ethambutol) along with oral corticosteroids. At 6-week follow-up, his visual acuity improved, and optic disc swelling had decreased.

Neuro-retinitis may be the initial presenting feature of disseminated TB. Clinicians should consider TB in the differential diagnosis of neuro-retinitis, particularly in high-prevalence settings. Early systemic evaluation and prompt initiation of anti-TB therapy can lead to favorable visual and systemic outcomes.