Anthony Yao1, Craig Aboltins2, Alan A McNab3,4, Cesar Salinas-La Rosa5, Justin Denholm6,7, Jwu Jin Khong8,9,10. 1. Department of Ophthalmology, Austin Health, Heidelberg, Victoria, Australia. 2. Department of Infectious Diseases, St Vincent's Hospital, Fitzroy, Victoria, Australia. 3. Orbital, Plastics and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, 32 Gisborne St, East Melbourne, VIC, Australia. 4. Centre for Eye Research Australia, Department of Surgery, University of Melbourne, East Melbourne, Victoria, Australia. 5. Department of Anatomical Pathology, St Vincent's Hospital, Fitzroy, Victoria, Australia. 6. Victorian Tuberculosis Program, Melbourne Health, Melbourne, Victoria, Australia. 7. Department of Microbiology and Immunology at the Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia. 8. Department of Ophthalmology, Austin Health, Heidelberg, Victoria, Australia. khongj@unimelb.edu.au. 9. Orbital, Plastics and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, 32 Gisborne St, East Melbourne, VIC, Australia. khongj@unimelb.edu.au. 10. Centre for Eye Research Australia, Department of Surgery, University of Melbourne, East Melbourne, Victoria, Australia. khongj@unimelb.edu.au.
Abstract
PURPOSE: Orbital tuberculosis (TB) is a rare extra-pulmonary manifestation of tuberculosis and its clinical diagnosis poses unique challenges, with potential for destructive complications as well as social and public health implications. The aim of this study is to report our experience of patients presenting with orbital TB and to identify common aspects. METHODS: A systematic search for mandatory notifications of orbital tuberculosis between January 01, 1994 and December 12, 2016 was undertaken in the Victorian Tuberculosis database. In addition, members of the Australian and New Zealand Society of Ophthalmic Plastic Surgeons (ANZSOPS) were surveyed to identify cases of orbital tuberculosis diagnosed on biopsy in the past 20 years. Medical case notes of identified cases were reviewed retrospectively. RESULTS: Three cases were identified as having occurred in Victoria, aged 44-59 years old. All cases had emigrated from endemic countries with higher tuberculosis burden. Diagnosis of tuberculosis was often difficult due to few or non-viable acid fast bacilli and low yield of positive culture in paucicellular orbital specimens. CONCLUSIONS: Orbital TB is rare but remains an important differential diagnosis of orbital mass lesions. The diagnosis of orbital TB requires a high index of clinical suspicion and targeted investigations in patients originating from endemic areas. Diagnosis and treatment rely on effective collaboration between ophthalmologists, infectious disease physicians, and pathologists.
PURPOSE:Orbital tuberculosis (TB) is a rare extra-pulmonary manifestation of tuberculosis and its clinical diagnosis poses unique challenges, with potential for destructive complications as well as social and public health implications. The aim of this study is to report our experience of patients presenting with orbital TB and to identify common aspects. METHODS: A systematic search for mandatory notifications of orbital tuberculosis between January 01, 1994 and December 12, 2016 was undertaken in the Victorian Tuberculosis database. In addition, members of the Australian and New Zealand Society of Ophthalmic Plastic Surgeons (ANZSOPS) were surveyed to identify cases of orbital tuberculosis diagnosed on biopsy in the past 20 years. Medical case notes of identified cases were reviewed retrospectively. RESULTS: Three cases were identified as having occurred in Victoria, aged 44-59 years old. All cases had emigrated from endemic countries with higher tuberculosis burden. Diagnosis of tuberculosis was often difficult due to few or non-viable acid fast bacilli and low yield of positive culture in paucicellular orbital specimens. CONCLUSIONS: Orbital TB is rare but remains an important differential diagnosis of orbital mass lesions. The diagnosis of orbital TB requires a high index of clinical suspicion and targeted investigations in patients originating from endemic areas. Diagnosis and treatment rely on effective collaboration between ophthalmologists, infectious disease physicians, and pathologists.
Entities:
Keywords:
Infection; Mycobacterium tuberculosis; Orbit; Orbital masses
Authors: Tahrina Salam; J M Uddin; J R O Collin; D H Verity; M Beaconsfield; Geoffrey E Rose Journal: Br J Ophthalmol Date: 2014-12-03 Impact factor: 4.638