Petrushkin et al reported the pan-LOndon Ocular tuberculosis Pathway for evaluating a patient for ocular tuberculosis. The authors are from multple institutions in London.

Patient selection: possible ocular tuberculosis


Ocular phenotype consistent with tuberculosis:

(1) chronic granulomatous anterior uveitis

(2) choroidal granuloma

(3) serpiginous chorioretinitis

(4) peripheral occlusive vasculitis


Other high-risk phenotypes:

(1) idiopathic granulomatous uveitis with suspicion for tuberculosis

(2) nongranulomatous anterior uveitis with (other causes excluded) AND (poor response to topical therapy)


Reasons to pursue the diagnosis of tuberculosis:

(1) positive interferon gamma release assay

(2) strong clinical or epidemiological suspicion of tuberculosis

(3) positive optional investigations:(a) tuberculin skin test; (b) CT chest; (c) FDG PET scan


If it is decided to treat as tuberculosis:

(1) treat with rifampin, isoniazid, pyrazinamide AND (ethambutol OR moxifloxacin) for 2 months

(2) follow with rifampin and isonazid for 7 months

(3) evaluate at 2, 6 and 9 months after start of therapy in a tuberculosis clinic

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