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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

• Ethambutol

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)