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Tuberculous orbital apex syndromes
  1. E H Hughes1,
  2. H Petrushkin1,
  3. N A Sibtain2,
  4. M R Stanford1,
  5. G T Plant1,
  6. E M Graham1
  1. 1
    Medical Eye Unit, St Thomas’ Hospital, London, UK
  2. 2
    Department of Radiology, St Thomas’ Hospital, London, UK
  1. Dr E M Graham, Medical Eye Unit, St Thomas’ Hospital, London SE1 7EH, UK; elizabeth.graham{at}


Aims: To describe the clinical and radiological features of orbital apex syndromes caused by presumed tuberculosis (TB).

Methods: A review of the discharge summaries of all patients seen in the Medical Eye Unit (MEU), St Thomas’ Hospital between 1975 and 2006 identified seven patients with a diagnosis of orbital apex syndrome or optic neuropathy attributable to TB. Case notes and radiology were reviewed retrospectively for each patient.

Results: All of the patients were born outside the UK and were HIV-negative. Four presented during 2005–6. Six of the seven patients presented with a visual acuity (VA) of less than counting fingers (CF), but all achieved a VA of 6/9 or better after a median 3 weeks of treatment with antituberculous treatment and systemic corticosteroids. All patients had constitutional symptoms. Chest x ray and CSF were normal in each case, but MRI was abnormal in six.

Conclusions: We report a recent cluster of tuberculous orbital apex syndromes, in the context of an increasing incidence of TB in the UK. The condition is difficult to diagnose, but the combination of high-dose corticosteroids and anti-TB medication was rapidly effective and achieved a good outcome in all cases.

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  • Competing interests: None.