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  • Title: Orbital tuberculosis: a review of the literature.
    Author: Madge SN, Prabhakaran VC, Shome D, Kim U, Honavar S, Selva D.
    Journal: Orbit; 2008; 27(4):267-77. PubMed ID: 18716964.
    Abstract:
    PURPOSE: 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.
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