Ocular tuberculosis in Iran: a systematic review of case reports, case series, and observational studies

Abstract Background Ocular tuberculosis (OTB) is an uncommon extrapulmonary form of tuberculosis with diverse clinical features and no definitive diagnostic gold standard. In Iran, diagnosis is often presumptive, which may lead to misclassification and under recognition. Methods This systematic review followed PRISMA guidelines and the Declaration of Helsinki. PubMed/MEDLINE, Scopus, Web of Science, Google Scholar and Persian-language national databases (SID, Magiran, IranMedex/Barakat) were searched up to 18 August 2026 for studies reporting OTB in Iran. Data on clinical presentation, diagnostic methods, treatment, and outcomes were extracted and synthesized qualitatively. Study quality was assessed using Joanna Briggs Institute critical appraisal tools. Results Thirteen studies involving 31 patients were included. The most common manifestations were uveitis, choroiditis, and chorioretinitis. Diagnosis was usually presumptive and based on clinical findings, tuberculin skin test, interferon-gamma release assay, imaging, and response to anti-tubercular therapy. Microbiological confirmation was rare. Most patients improved with treatment, although diagnostic approaches varied substantially across reports. Conclusions OTB in Iran remains diagnostically challenging and clinically heterogeneous, with uveitis and choroidal or chorioretinal involvement representing the most frequently reported ocular presentations, but outcomes are generally favorable with appropriate therapy. Standardized diagnostic criteria, broader access to molecular testing, and national registries are needed to improve recognition and define disease burden more accurately. Trial registration PROSPERO CRD420261369933.