Intraocular Tuberculosis: Current Insights and Emerging Therapeutic Paradigms

Background Intraocular tuberculosis (OTb) is a sight-threatening manifestation of Mycobaterium tuberculosis infection. It is characterized by a wide spectrum of clinical phenotypes, including anterior uveitis, posterior uveitis, retinal vasculitis, and choroiditis. Diagnosis remains challenging due to its diverse clinical presentations and the absence of standardized criteria. This review summarizes current knowledge on the clinical spectrum, diagnostic modalities, and emerging management strategies for OTb. Methods A comprehensive systemic literature search was conducted on Medline and PubMed to identify relevant studies on ocular tuberculosis. Results Key diagnostic tools include optical coherence tomography (OCT), fluorescein angiography (FA), interferon-gamma release assays (IGRA), polymerase chain reaction (PCR), and high-resolution computerized tomography (HRCT). Management typically involves a combination of anti-tuberculosis therapy (ATT) and corticosteroids, although optimal treatment regimens remain a topic of ongoing debate. Emerging challenges in treatment include paradoxical worsening, drug resistance, and corticosteroid dependency. Recent advancements, such as intravitreal anti-VEGF agents, moxifloxacin, and immunomodulatory therapy, have shown promise in refractory cases. Conclusion A multidisciplinary approach is essential for the timely diagnosis, individualized treatment, and improved visual outcomes in patients with intraocular tuberculosis.