Orbital tuberculosis: a review of the literature.
OBJECTIVE
To provide an up-to-date review of the clinical presentations, investigations, and management of orbital tuberculosis (OTB).


METHODS
Systematic review of the literature concerning OTB, limiting the results to English-language peer-reviewed journals.


RESULTS
Seventy-nine patients from 39 publications were identified as cases of OTB. The condition presents in one of five forms: classical periostitis; orbital soft tissue tuberculoma or cold abscess, with no bony involvement; OTB with bony involvement; spread from the paranasal sinuses; and tuberculous dacryoadenitis. The ocular adnexa, including the nasolacrimal system and overlying skin, may also be involved.


CONCLUSIONS
Diagnosis can be difficult and may necessitate an orbital biopsy, in which acid-fast bacilli (AFB) and characteristic histopathology may be seen. Growth of Mycobacterium tuberculosis (mTB) from such a specimen remains the gold standard for diagnosis. Ancillary investigations include tuberculin skin tests and chest radiography, but more recently alternatives such as whole blood interferon-gamma immunological tests and PCR-based tests of pathological specimens have proven useful. The management of OTB is complex, requiring a stringent public health strategy and high levels of patient adherence, combined with long courses of multiple anti-tuberculous medications. The interaction of the human immunodeficiency virus (HIV) with TB may further complicate management.
Madge
Simon N
SN
Oculoplastic & Orbital Division, Discipline of Ophthalmology and Visual Sciences, Level 8, Royal Adelaide Hospital, North Terrace, Adelaide 500, Australia. drsimonmadge@gmail.com
Prabhakaran
Venkatesh C
VC
Shome
Debraj
D
Kim
Usha
U
Honavar
Santosh
S
Selva
Dinesh
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007371:Interferon-gamma / Q000097:blood; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D009916:Orbital Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D013902:Radiography, Thoracic; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014374:Tuberculin Test; D014392:Tuberculosis, Ocular / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology
D000995:Antitubercular Agents; D007371:Interferon-gamma