Tuberculosis and the Eye

Update item information
Identifier Tuberculosis_and_the_Eye
Title Tuberculosis and the Eye
Subject Tuberculosis, Neuro-ophthalmology, Medical condition
Creator Andrew G. Lee, MD, Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, TX; Professor of Ophthalmology, Weill Cornell Medicine; Akash Gupta, Baylor College of Medicine Class of 2022
Description Dr. Lee lectures medical students on Tuberculosis and the eye.
Transcript So today we're gonna be talking about tuberculosis and the eye and TB is just like syphilis it's a great mimicker so we should be considering tuberculosis and any unexplained neuroophthalmic finding especially. However if the patient has risk factors and the risk factors for tuberculosis worldwide are if you're from an endemic area so many countries in the world have syphilis and tuberculosis that are in endemic rates and so we need to know kind of the map of the world of where the countries that still have tuberculosis are. In addition, in the United States we're going to be thinking about health care workers like ourselves and that's why we're tested yearly for tuberculosis because we're exposed. People are in crowded situations, homeless people prisoners and in our state especially Texas, new immigrant populations. So the questions for these people are: did you come from an endemic area and how soon did you come was it three years ago five years ago? So if you're within five years from an endemic area we really should be still considering tuberculosis in the differential diagnosis. And TB can affect the entire eye all the way from the front of the eye to the occipital lobe and so we should be thinking in any unexplained inflammatory process that means: episcleritis, scleritis, conjunctivitis, uveitis, intermediate uveitis, pars planitis, posterior segment involvement, choreoretinitis, retinitis, vitritis, optic neuritis, scleritis. So if you've got itis anywhere in your eye it could still be TB. And normally it looks like granulomatous disease so we have it in the differential diagnosis of all the patients who have what we're thinking about sarcoid a non-caseating granuloma tuberculosis is still in the differential a caseating type of granuloma and really the only way to differentiate these two is with pathology they look the same. So just like sarcoid can do anything and syphilis can do anything, tuberculosis can do anything but you really should be thinking about it when you see that granulomatous type uveitis in the anterior or the posterior segment. Inside the head we're gonna be thinking about meningitis, myelitis, meningoencephalitis, and it can present with unexplained cranial neuropathies or optic neuritis optic atrophy optic disc edema and optic disc edema with a macular star figure infectious neuroretinitis we should be thinking about tuberculosis in those settings. So TB should be on your differential pretty much every time but especially in high-risk populations immigrant populations travel to or they're from an endemic area. And we've moved away from the skin test which is the purified protein derivative the PPD and in our center we're now using the interferon gamma release assay. The interferon gamma release assay has various names different companies QuantiFERON TB spot tests, but the interferon gamma release assay is less susceptible to the problems that we had with the PPD where we had to have it reread you had to come back two days later. It's a blood test, it's way faster, and people who have received the BCG vaccine are less likely to have a false reaction if you use the interferon gamma release assay. And we pair that with a chest x-ray, so if the patient is not symptomatic pulmonary wise and they have had an interferon gamma release assay that's negative and a chest x-ray that's normal I think that's pretty good for excluding tuberculosis in our neuroophthalmic patients. So bottom line you should be thinking about TB in any of these risk factor patients endemic areas' immigrants any unexplained anterior posterior segment inflammation and in the brain any type of unexplained optic atrophy unexplained ocular motor cranial neuropathy. And in high-risk patients and we're moving away from the PPD towards just using the interferon gamma release assay and the chest x-ray.
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Type Image/MovingImage
Format video/mp4
Rights Management Copyright 2020. For further information regarding the rights to this collection, please visit:
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E, SLC, UT 84112-5890
Collection Neuro-ophthalmology Virtual Education Library: NOVEL
Language eng
ARK ark:/87278/s6fz2qgx
Setname ehsl_novel_lee
Date Created 2020-05-27
Date Modified 2020-06-01
ID 1561535
Reference URL