Abstract
Background Ocular tuberculosis is a rare but important differential diagnosis for inflammatory
conditions of all eye tissues, including the ocular surface and adnexa. Tissue
diagnostics may prove challenging as some ocular tissues are difficult to biopsy
and the detection of pathogens may be insensitive. We were interested in how many
cases in the archive of the
ophthalmopathological laboratory had been diagnosed with (peri)ocular tuberculosis
since 1945.
Materials and Methods Retrospective analysis of historical records and specimens of the ophthalmopathology
laboratory of the eye department at Freiburg university hospital.
Systematic re-evaluation of available slides for presence of granuloma, necrosis,
giant cells, acid fast bacteria, and chronic as well as acute inflammation, plus comparison
of current and
historic evaluations. In addition, we describe a recent case with tuberculoma
of the iris.
Results There were 50,418 records archived since 1945, of which 23 specimens taken from 22
patients had been diagnosed as (peri)ocular tuberculosis. Of these, 22 (96%) were
archived
and available for re-interpretation. Four specimens (17%) had been excised from
children. The most common tissues were enucleated eye globes (10/23, 44%), followed
by the lacrimal sac (5/23,
22%) and conjunctiva (2/23, 9%). The most frequent histopathological findings
were granulomas (23/23, 100%), chronic inflammation (22/23, 96%), giant cells (21/23,
91%), and necrosis (14/23,
61%). An acute inflammatory response was found in 4/23 specimens (17%). Ziehl-Neelsen
stains for acid-fast bacteria had been performed in five cases, of which three were
positive (60%). The
greatest discrepancy between current and historical findings related to the presence
of necrosis (59% consensus). In other findings, the consensus was high (78 – 96%).
In a recent case of a
patient with wasting syndrome attributed to lymphoma, histopathological workup
of an iris tumour led to the diagnosis of tuberculosis.
Conclusion Ocular tuberculosis is a rare but important histopathological differential diagnosis.
In the available specimens, the classic finding of necrotizing inflammation was
rarest and showed least consensus on histological re-evaluation. Other typical
findings, such as giant cells and a predominantly lymphocytic infiltrate, are sometimes
not found even with
proven presence of Mycobacterium tuberculosis. They should not be considered
essential in cases where there is strong clinical suspicion.
Key words
tuberculosis - iris - eye - ophthalmopathology
