• 1 Hospital Tengku Ampuan Rahimah
  • 2 Hospital Shah Alam
  • 3 Universiti Sains Malaysia


Tuberculosis, an ancient disease, still thrives today as the leading
infection caused by Mycobacterium tuberculosis. Diagnosis of ocular
tuberculosis poses a great challenge due to the varied clinical presentations.
We report 3 cases of primary ocular tuberculosis with varied presentations:
conjunctival abscess, sclera-uveitis and occlusive vasculitis. There were no
symptoms suggestive of pulmonary tuberculosis in all cases. All patients
presented with acute, unilateral painful red eye. The first case had good visual
acuity (VA) OD (6/9) with a swollen upper lid, localized perilimbal-hemorrhagic
conjunctival swelling superiorly, keratic precipitates and mild anterior chamber
reaction. The posterior segment was normal. The second case had a VA of 6/60
OD. There was presence of conjunctival injection, keratic precipitates, posterior
synechiae and anterior chamber reaction of 1+. A few days later, there was a
progression to vitritis OU and hyperemic optic disc OD with choroidal folds,
cystoid macula edema and a positive T sign on B scan ultrasonography. The
third case had VA of 6/6 OU, AC reaction of 2+ OD. There was multiple
peripheral choroiditis with peripheral vasculitis seen in the posterior segment
OU. Fundus fluorescein angiography (FFA) showed peripheral periphlebitis in
all 4 quadrants OU. All 3 cases had positive Tuberculin Skin Test (Mantoux test)
results which were more than 20mm. Anti-tuberculous treatment was promptly
started and all patients showed significant clinical improvement. This case
series highlights the diverse clinical presentations of ocular tuberculosis. A high
clinical index of suspicion led to prompt initiation of anti-tuberculous therapy
which resulted in good clinical outcomes for all cases.