Tuberculosis may manifest in the eye with no viable Mycobacterium Tuberculosis bacteria detectable by culture or biopsy. In such patients indirect evidence suggests Tuberculosis and the diagnosis is then termed “Presumed Ocular Tuberculosis”. These patients present with relapsing ocular inflammation with features and patterns specific to “Ocular Tuberculosis”, and inflammation uncontrolled with steroids &/or immunosuppressives. They have a positive Mantoux test & no evidence of systemic Tuberculosis on systemic examination and with baseline and/or advanced investigations. These patients should be treated with anti-tuberculosis drugs, especially when a systemic steroid regimen is required.
A history of a BCG vaccine (>15 years) in a patient with a positive PPD skin test for TB does not rule out true TB infection.
Challenges faced in diagnosis and treatment of "Presumed Ocular Tuberculosis"
• "Presumed" Nature of Diagnosis
• Requirement of knowledge of clinical patterns of Tuberculosis in the eye for diagnosis
• No Systemic Tuberculosis
• Correct Interpretation of Mantoux Test
• No other tests suggestive of Tuberculosis
• Repeated Patient Counselling for Treatment
Knowledge of features of "Presumed Ocular Tuberculosis" is important as treatment with anti-tuberculosis drugs achieves long term control of inflammation in these patients as experienced by Dr. Mayur R. Moreker.