inflamation session - All India Ophthalmological Society

INFLAMMATION SESSION307country like India, TB causing ocular and orbitaldisease has become increasingly rare. 2 Theincidence of ocular tuberculosis in a population isdifficult to estimate. The incidence of tubercularuveitis in India has varied from 2 to 30%. 3,4 Thislarge variation in incidence rate in differentreports possibly suggest the difference indiagnostic criteria.Ocular tuberculosis can be of two types –primary and secondary. The term primary oculartuberculosis has been used when tuberculouslesions are confined to eyes and no systemiclesions are clinically evident. The term has alsobeen used to describe the cases where the eye hasbeen the initial portal of entry. Secondary oculartuberculosis has been defined as ocular infectionresulting from contiguous spread from adjacentstructures or hematogenous spread from lungs.The various clinical presentations of oculartuberculosis are – Uveitis (Anterior andposterior), Episcleritis, Phlyctenular conjunctivitis,Eale’s disease, orbital tuberculosis etc.Definitive diagnosis of ocular tuberculosis can bemade only by demonstrating mycobacteriumtuberculosis in the ocular tissue. However,obtaining ocular tissue for diagnostic purposes isnot only difficult but also associated withsignificant ocular morbidity. Therefore, a highdegree of clinical suspicion is the key to earlydiagnosis.The clinical diagnosis of ocular tuberculosis maybe based on presence of atleast 3 of the following5 feature: (i) Suggestive clinical picture (ii)Exclusion of other aetiologies (iii) PositiveMantoux test (iv) Therapeutic response to antituberculartherapy and (v) Present or past historyof tuberculosis.The pathogenesis of ocular tuberculosis is basedon Rich’s Law which states that : Ocular lesion isdirectly proportional to Number and virulence oforganisms degree of hypersensitivity/Hostresistance.To focus on the diversity of clinical presentationof ocular tuberculosis and discuss the diagnosticapproach and an effective treatment.Materials and MethodsOur study enrolled 30 consecutive patientsduring a period of 1 year. All the cases fulfillingthe diagnostic criteria for ocular tuberculosiswere included in the study. All the casesunderwent detailed ophthalmic evaluationincluding a detailed history, visual assessment,slit lamp biomicroscopy, applanation tonometeryand Indirect ophthalmoscopy with scleralindentation.Systemic investigations included a completeblood count, erythrocyte sedimentation rate(ESR), Mantoux test, Chest X-Ray and detailedevaluation of immunosuppressive disorders forHIV by enzyme linked immunosorbent assay(ELISA). FFA was done wherever required.Diagnosed Pediatric patients of tubercularmeningitis already on ATT, referred to us forophthalmic examination – VEP was advised forchildren with non-reacting pupil and alteredsensorium .In our study, topical steroids, ATT and systemicsteroids wherever necessary gave good results.ResultsTuberculosis of eye were uniocular in 16 patientsand binocular in 14 patients. As per Table-3, thecondition was more in males than females. Themale:female ratio was found to be 1.3:1 . Table 1Table-1Clinical manifestation No.of PercentagePatients %B/L recurrent Chalazia 2 7%Phlyctenular Conjunctivitis 6 20%Episcleritis 5 17%Chr. Granulomatous uveitis 5 17%Choroiditis 4 13%Peripheral uveitis 1 2.5%Eale’s disease 2 7%Recurrent CSR 2 7%MR palsy 1 2.5%Toxic amblyopia sec to ATT 2 7%Table-230 100%Age in years No. of Patients Percentage%0-15 years 7 23%16 – 30 years 19 63%31 - 45 years 4 14%>45 years 30 100%Table-3: Sex incidenceSex No. of Patients Percentage %Male 17 57%Female 13 43%30 100%