Presumed Intraocular Tuberculosis in a Foreign Worker

Purpose: To report a Thai foreign worker with intraocular tuberculosis. Methods: Interventional case report. Results: A 33-year-old Thai male working in a Taiwan factory complained of blurred vision. Fundoscopy revealed perivenous sheathing, intraretinal hemorrhages and cotton-wool spots. Neovascularization on the optic nerve head and preretinal hemorrhage were noted. Optical coherence tomography revealed serous retinal detachment. Acid fast stain and GEN-PROBE amplified Mycobacterium tuberculosis direct test of aqueous were negative. The tuberculin skin test was positive. After anti-tuberculosis therapy, locally administered ocular corticosteroids and laser treatment, intraretinal hemorrhages and cotton-wool spots subsided. Vision also improved. Conclusions: High rates of tuberculosis have been documented in immigrants and migrants. Most individuals affected are workers. Diagnosis of intraocular tuberculosis is difficult due to the inability to demonstrate acid-fast bacilli on smear or histopathology in ocular specimens and the paucity of available ocular tissue. A high index of suspicion accompanied by tuberculin skin test or PCR of aqueous is mandatory for the early detection and management. Anti-tuberculosis therapy, corticosteroids and timely laser treatment are the key elements required to salvage vision.