PT  - JOURNAL ARTICLE
AU  - Hughes, E H
AU  - Petrushkin, H
AU  - Sibtain, N A
AU  - Stanford, M R
AU  - Plant, G T
AU  - Graham, E M
TI  - Tuberculous orbital apex syndromes
AID  - 10.1136/bjo.2008.138974
DP  - 2008 Nov 01
TA  - British Journal of Ophthalmology
PG  - 1511--1517
VI  - 92
IP  - 11
4099  - http://bjo.bmj.com/content/92/11/1511.short
4100  - http://bjo.bmj.com/content/92/11/1511.full
SO  - Br J Ophthalmol2008 Nov 01; 92
AB  - 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.