Ocular tuberculosis: a case series of a Portuguese district hospital

Purpose To describe the clinical manifestations, management and outcomes of ocular tuberculosis (OTB) in a district hospital serving a high-migration area. Methods Retrospective case series of patients treated for OTB. Inclusion criteria required adherence to antitubercular therapy (ATT) for 6–12 months and ≥12 months of follow-up. Demographics, clinical phenotype, ancillary testing (immunological tests and chest imaging), adjuvant immunosuppressive therapy, adverse events, ocular inflammation evolution and best-corrected visual acuity (BCVA) were recorded. A favourable outcome was defined as an improvement of at least 0.2 logMAR or achieving logMAR 0.0, accompanied by a reduction in ocular inflammation. Results 38 patients (61 eyes; mean age 52.3±15.8 years) were included, of which 28.9% were non-Portuguese. Bilateral disease occurred in 58%. No ocular samples were microbiologically positive; 39.5% met the criteria for presumed OTB and 60.5% for possible OTB. Immunological testing was positive for both interferon-gamma release assay (IGRA) and tuberculin skin test (TST) in 71.1%, IGRA-only in 23.7% and TST-only in 5.3%. Posterior-segment involvement predominated (68.5%), most commonly posterior uveitis (21.1%), panuveitis (23.7%) and retinal vasculitis (15.8%). Overall, 84.2% received immunosuppressive therapy, namely steroid therapy and/or steroid-sparing agents. At 12 months, 92.1% showed inflammatory improvement, and 68.4% achieved the BCVA outcome. Adverse events included deranged liver function (13.2%), rash (5.3%), cataract (5.3%) and ocular hypertension (7.9%). Conclusions In this low-incidence country with localised higher-risk areas, OTB presented predominantly with posterior-segment phenotypes. Combined ATT with immunomodulation achieved high inflammatory control and meaningful visual gains with acceptable toxicity, underscoring the importance of early recognition and multidisciplinary management.