RT Journal Article
SR Electronic
T1 Tuberculous orbital apex syndromes
JF British Journal of Ophthalmology
JO Br J Ophthalmol
FD BMJ Publishing Group Ltd.
SP 1511
OP 1517
DO 10.1136/bjo.2008.138974
VO 92
IS 11
A1 Hughes, E H
A1 Petrushkin, H
A1 Sibtain, N A
A1 Stanford, M R
A1 Plant, G T
A1 Graham, E M
YR 2008
UL http://bjo.bmj.com/content/92/11/1511.abstract
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.