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At the end of the 19th century, German scientists proved that the tuberculosis process affects the organ of vision. The scientist transplanted small biopsies from other organs of tuberculosis patients into the anterior chamber of the eye. It was found that over time, ocular tuberculosis progressed, and was accompanied by formation of tubercles of a specific nature in the structures of the eye. Among extrapulmonary forms of tuberculosis, damage to the organ of vision occupies the 4th place. In recent decades, the frequency of eye tuberculosis has been increasing, the disease is common among middle-aged and young people, mainly women. Read on estet-portal.com how to recognize and diagnose the tuberculous process of the eye.

Causes and mechanism of eye tuberculosis development

Mycobacteria tuberculosis from tuberculous granuloma hematogenously gets into the organ of vision.

Eye tuberculosis can develop at any stage of the tuberculosis process. The vessels of the choroid, which have an average diameter, are the first to be affected. Tuberculosis of the eye at first has an asymptomatic abortive character.

Then, the inflammatory process spreads to retina and choriocapillary sections. At this stage of the process, symptoms of eye tuberculosis appear. Other structures of the eye may be involved in the process, due to the perifocal response of tissues to inflammation.

Tuberculosis-allergic reaction in the tissues of the eye occurs due to increased sensitivity to mycobacteria. Antigen from the focus of tuberculosis infection  penetrates into the eye. With the localization of a specific tubercle in the nervous system, a secondary eye lesion develops. Then the clinical symptoms will be due to increased intracranial pressure, which is due to compression of the optic nerve by the tuberculous tubercle.

Primary tuberculosis of the eye is characterized by the predominance of exudative processes over proliferative ones. The secondary stage develops with the advantage of proliferative processes, which is accompanied by the formation of specific granulomas. caseous necrosis develops in their central part. Tuberculous-allergic form of ocular tuberculosis is characterized by edema of surrounding tissues with lymphoplasmic infiltration.

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Clinical symptoms and course of ocular tuberculosis

Tuberculosis of the eyes in the tuberculosis-allergic form has an acute course with a rapid subsidence of symptoms. This type of pathological process is characterized by a tendency to frequent relapses, since the action of non-specific allergens constantly occurs.

With hematogenous dissemination, the onset of the disease is slow with a torpid course. Anti-inflammatory therapy has no effect.

There are such variants of eye tuberculosis:

  • chorioretinitis;
  • panuveitis;
  • peripheral and anterior uveitis.

Symptoms of eye tuberculosis, depending on location:

  • Loss of anterior parts of the choroid accompanied by a feeling of "fog"; before the eyes, lacrimation, photophobia, a feeling of heaviness in the eye socket and a progressive decrease in visual acuity.
  • Peripheral tuberculous uveitis accompanied by "floating opacities" in the field of view and a decrease in the function of central vision.
  • If ocular tuberculosis occurs with an inflammatory process in the retina and choroid, patients complain of mist before the eyes or black spots, watery eyes, pain in the eyeballs and increased sensitivity to light.
  • panuveitis is characterized by a decrease in visual acuity and the presence of a pronounced pain syndrome.
  • Tuberculosis process in the conjunctiva is often unilateral. There are no symptoms until a secondary infection or the formation of tuberculous nodules.

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Basic methods of diagnosis and treatment of ocular tuberculosis

Diagnosis of the pathological tuberculous process in the eyes is based on several instrumental methods:

  • ophthalmoscopy - visualization of round lesions in the choroid and retina;
  • Biomicroscopy – with a slit lamp, large precipitates on the cornea and posterior synechiae can be seen;
  • tonometry;
  • visometry;
    • cytological and histomorphological examination of the biopsy specimen
  • in order to detect mycobacteria. When the contents of the vitreous body or the anterior chamber of the eye are aspirated after iridectomy, their cytological examination is performed.

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In the case of conjunctival tuberculosis, biomicroscopy can detect numerous gray nodules that tend to coalesce. A month later, they
are expressed, forming a deep

ulcer surface. The diagnosis of ocular tuberculosis is confirmed after evaluating the local tissue response to tuberculin administration. The introduction of tuberculin is accompanied by a short-term increase in the symptoms of eye tuberculosis.

Treatment of eye tuberculosis is carried out after establishing the form and severity of the process. For therapy, antibiotics of the
aminoglycoside group,

and   other drugs that are active against mycobacteria are used. The duration of the course of therapy lasts from 2 to 5 months. Antibacterial agents for ocular tuberculosis are administered in the form of parabulbar injections, as well as by electrophoresis.

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