Sight, Society, and Survival: Navigating the Diagnostic Dilemmas and Treatment Realities of Ocular Tuberculosis

Background: Ocular tuberculosis (OTB) is an under-recognized manifestation of extrapulmonary tuberculosis and often presents a diagnostic challenge because its clinical features can mimic other inflammatory eye diseases. Delayed recognition may lead to significant visual morbidity. This study aimed to evaluate the clinical profile and socio-demographic characteristics of patients with ocular tuberculosis and to assess the impact of structured counseling regarding the National Tuberculosis Elimination Program (NTEP) on treatment awareness and adherence.

Methods: A prospective, hospital-based observational study was conducted over an 18-month period. Among 33,506 ophthalmology outpatients, 62 patients diagnosed with intraocular tuberculosis were enrolled based on the criteria of the Collaborative Ocular Tuberculosis Study (COTS) and the Standardization of Uveitis Nomenclature (SUN) group. All participants underwent detailed history was taken. Structured counseling was provided to educate patients about NTEP services, including free anti-tubercular therapy (ATT) and nutritional support through the Nikshay program.

Results: The hospital-based prevalence of ocular tuberculosis was 0.18%. The mean age of patients was 34.6 ± 11.2 years, with a predominance of males (58.1%) and individuals from rural areas (64.5%). Based on diagnostic classification, 45.2% of cases were categorized as Potential OTB, 48.4% as Clinically Established OTB, and 6.4% as Confirmed Bacteriological OTB. Posterior uveitis associated with retinal vasculitis was the most common presentation, affecting 48.8% of eyes. At baseline, severe visual impairment (<6/60) was present in 44.2% of affected eyes. Awareness of NTEP benefits at presentation was low (22.6%), and none of the patients were initially registered on the Nikshay portal. After structured counseling, all patients were enrolled, leading to a high treatment adherence rate of 93.5% at six months.

Conclusion: Ocular tuberculosis predominantly affects young adults from rural and lower socioeconomic backgrounds. Although it can cause significant visual impairment, timely treatment results in substantial recovery. Improving awareness of national TB programs through structured counseling significantly enhances treatment adherence and supports ongoing tuberculosis elimination efforts.