Ocular tuberculosis. A prospective study in a general hospital

Area of Science:

• Ophthalmology
• Infectious Diseases
• Public Health

Background:

• Ocular tuberculosis is historically considered rare, with diagnostic challenges due to imprecise criteria.
• The rise of extrapulmonary tuberculosis, particularly during the AIDS epidemic, highlighted the need for rigorous investigation of ocular involvement.

Purpose of the Study:

• To prospectively evaluate the incidence and characteristics of ocular tuberculosis in patients with culture-proven tuberculosis.
• To establish clear diagnostic criteria for ocular tuberculosis and identify associated risk factors.

Main Methods:

• A 15-month prospective study involving 100 randomly selected patients with culture-proven tuberculosis.
• Systematic ophthalmologic evaluations using defined criteria for certainty, probability, and possibility of ocular tuberculosis.
• Multivariate analysis to identify independent risk factors for ocular involvement.

Main Results:

• Ocular tuberculosis was diagnosed in 18% (18/100) of patients, with 11 of these patients also having HIV infection.
• Choroiditis was the most common finding (17/18), with other lesions including papillitis, retinitis, and vasculitis.
• Miliary disease (OR 43.92), ocular symptoms (OR 6.35), and decreased visual acuity (OR 0.04) were significant risk factors.

Conclusions:

• Ocular involvement is unexpectedly common in tuberculosis patients (18%), frequently asymptomatic.
• Miliary tuberculosis is a strong predisposing factor for ocular disease, irrespective of HIV status.
• Routine ocular examinations are recommended for all patients with suspected or proven tuberculosis.