Fundus Changes in Milliary Tuberculosis: A Retrospective Cohort Study

Abstract

Introduction: Milliary tuberculosis occurs due to haematogenous spread of infection. It is assumed that intraocular tuberculosis is spread hematogenously from primary infection to elsewhere. The choroidal tubercles may be one of the earliest signs of milliary disease and is probably the most common form of ocular tuberculosis.Methods: This is a retrospective observational single site study of 113 patients with milliary tuberculosis from 2001 to 2015. Fundus examination was done after full dilatation of the pupil with direct and indirect ophthalmoscope. The diagnosis of intraocular tuberculosis was presumed to be based on suggestive ocular lesion in context of evidence of systemic infection and response to antitubercular treatment.Results: There were 77 females (68%) and 36 (32%) males. The commonest age group was 21 to 40 years as 67 (59.3%) patients belonged to this productive age group. Eighty eight (77.9%) patients were from rural areas. Fundus changes were present in 14 patients (12.39%) and these were choroidal tubercles (8.8%), papillitis (4.4%), macular edema (0.9%) and vitritis (0.9%). Choroidal tubercles were present in 10 patients. Among these, two had associated papillitis and one also had vitritis. Three patients had only papillitis and in another one, only macular edema was present. Papillitis was present in five patients in our study. HIV did not increase the incidence of ocular lesions. Conclusion:The most common fundus changes were choroidal tubercles and optic neuropathy in our series. Early detection of these choroidal tubercles may be helpful in diagnosis as well as in treatment. The optic nerve may be involved not only by the toxic effect of anti-tubercular drug but also in the disease process itself.