Combined optic neuropathy and central retinal artery occlusion in presumed ocular tuberculosis without detectable systemic infection.

PURPOSE: To report a rare case of combined optic neuropathy and central retinal artery occlusion in presumed ocular tuberculosis without systemic infection. CASE REPORT: A young man presented with sudden onset of decreased vision in his left eye with combined optic disc swelling and central retinal artery occlusion in a background of vasculitic changes of the same eye. There were no signs or symptoms of active systemic tuberculosis infection. Chest X-ray and computed tomography thorax findings were normal and sputum cultures for tuberculosis were negative. The Mantoux and QuantiFERON-TB Gold tests were strongly positive. No tuberculosis polymerase chain reaction testing was done. Anti-tuberculosis therapy was initiated, based on the strong clinical evidence.
CONCLUSION: The ocular findings improved remarkably with the anti-tuberculosis treatment, although the left eye vision remained poor. A high index of suspicion is required to diagnose ocular tuberculosis when all other systemic investigations are negative, especially in this part of the world where tuberculosis is endemic.