A silent threat: Unveiling the cruelty of tuberculosis inside the eye

Abstract

This case report describes a 45-year-old female who presented with a progressive, painless diminution of vision in both eyes over the past eight months, accompanied by diffuse redness in eyes, bilateral eye pain, intermittent episodes of fever, and unintentional weight loss. The patient also reported sensorineural hearing loss of equal duration. Six months prior, she was diagnosed with pulmonary tuberculosis (TB) and initiated on anti-tubercular therapy (ATT). The constellation of ocular and systemic findings suggests ocular TB, likely manifesting as uveitis or optic neuritis, possibly exacerbated by an underlying systemic inflammatory response. Effective management required a multidisciplinary approach involving ophthalmologists and infectious disease specialists to address both ocular and systemic components of the disease. Further diagnostic workup, including detailed ophthalmic examination and relevant imaging, was crucial to evaluate the extent of ocular involvement and guide targeted therapy. This case highlights the need to maintain a high index of suspicion for tuberculosis in patients presenting with unexplained ocular symptoms, especially in regions where TB is endemic or in the presence of concurrent systemic signs.