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Ocular Manifestations
Ocular involvement occurs almost exclusively during active tuberculosis! Any ocular structure can be affected!
- Iris, choroidal tubercles
- Anterior uveitis
- Iris nodules (Koeppe nodules at the pupillary margin)
- Vitreous opacities
- Choroiditis
- Retinal periphlebitis
- Panophthalmitis
Indications for Therapy
- Active tuberculosis.
- Latent tuberculosis only if < 35 years old or immunocompromised (e.g., HIV).
Treatment
- Genetic rifampicin resistance determination (GeneXpert® PCR) before starting treatment
- Consult infectious disease specialist in case of resistance
- Isoniazid 1×5 mg/kg body weight p.o., max. 300 mg for 6 months
- + Rifampicin 1×10 mg/kg body weight p.o., max. 600 mg for 6 months
- + Pyrazinamide 1×25 mg/kg body weight p.o., max. 2000 mg for 2 months
- + Ethambutol 1×15–25 mg/kg body weight p.o., max. 2500mg for 2 months
- May be stopped early in case of good sensitivity
- CAUTION: Monitor transaminases after 2 and 4 weeks
- If anterior uveitis responds well to only local steroid therapy, tuberculosis is likely not the cause
Side Effects
Sources
- EyeWiki Tuberculosis Uveitis
- Antibiotika-Richtlinien Inselspital Bern
- The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
- Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)