A consultant ophthalmologist, Dr Yewande Babalola, has warned that tuberculosis (TB) can silently attack the eye, mimic serious conditions including cancer and eventually cause irreversible loss of vision. Babalola gave the warning while delivering a Faculty Lecture at the College of Medicine, University of Ibadan. She described ocular tuberculosis as a rare extra-pulmonary manifestation of TB, which can affect virtually every part of the eye.
Babalola explained that ocular TB most commonly reaches the eye through the bloodstream, particularly the highly vascularised uvea and choroid. She cited a Nigerian case reported in 1978 involving a one-year-old boy who was suspected of having retinoblastoma, a serious childhood eye cancer. The child was thought to have retinoblastoma and the eye was removed, but histopathology revealed tuberculosis.
According to Babalola, the eye can serve as a "window" or "mirror" to the body, with findings in the eye sometimes providing clues to disease elsewhere in the body. She said ocular tuberculosis is a great mimicker, with manifestations that can resemble those of several other diseases, making diagnosis difficult. This underscores the need for clinicians to consider TB when evaluating unusual ocular lesions.
Babalola recalled the case of a 33-year-old HIV-positive woman receiving treatment for drug-resistant pulmonary TB. While one eye was blind, the apparently healthy eye had lesions at the back that indicated ocular TB. This shows that ocular tuberculosis can be symptom-less, and the patient may not even know that there is tuberculosis in the eye.
The ophthalmologist expressed concern over the limited research and documentation on ocular TB in Nigeria, saying the paucity of recent studies made it difficult to determine the current burden of the disease in the country. She said her interest in ocular TB began about 17 years ago during her ophthalmology residency at the University College Hospital, Ibadan.
To address the knowledge gap, Babalola disclosed that she had developed the POS-OC-TB (Point of Screening for Ocular Tuberculosis) project to improve awareness, screening and referral for ocular tuberculosis. The idea is to educate physicians and other healthcare workers, screen TB patients for ocular manifestations and encourage referral to ophthalmologists.
Babalola called for stronger collaboration among ophthalmologists, physicians, TB specialists and other healthcare professionals to improve the detection and management of ocular TB. She emphasized that healthcare workers need to understand that TB is not limited to the lungs and can affect the eye without obvious symptoms.
Key points
- Ocular tuberculosis can mimic other serious eye conditions, including cancer.
- The eye can serve as a "window" or "mirror" to the body, with findings in the eye sometimes providing clues to disease elsewhere in the body.
- There is a need for greater awareness and research into ocular tuberculosis in Nigeria.
