Orbital tuberculosis: perspectives from Victoria, Australia

Challenges and Insights in the Diagnosis and Management of Orbital Tuberculosis: A Systematic Review of 113 Cases

Orbital tuberculosis (O-TB) is an extremely rare manifestation of extra-pulmonary tuberculosis (TB), which affects orbital structures and causes very complex clinical scenarios that may simulate other pathologies affecting the orbit. Its diagnostic and therapeutic challenges are due to its rarity and lack of specificity on symptoms. This systematic review aims to give an in-depth analysis regarding the presentation of clinical features, diagnosis methods, treatment outcomes, and complications, enhancing the current understanding and management of O-TB. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Literature searches were conducted in PubMed and Scopus up to August 2024. The literature review included case series, case reports, and retrospective studies focusing on O-TB and involved a total of 113 cases from 12 studies. The extracted data were qualitatively synthesized regarding patient demographics, clinical presentations, diagnostic methods, treatment regimens, and the ensuing outcomes. The review found that O-TB mostly affects subjects with a mean age of 37.75 years, although there is a very wide age range of reported cases: 2-82 years with an almost equal gender distribution. The most common symptoms were vision impairment at 71.68%, eyelid swelling at 9.73%, and exophthalmos at 5.31%. Imaging, especially with computed tomography (CT) scans in 60.18% of patients, along with histopathological confirmation and molecular biological confirmation positive in 46.02%, was the principal tool for diagnosis. In most cases, antitubercular therapy (ATT) was the mainstay of treatment, leading to complete resolution. However, 30.09% of these cases had some complications like glaucoma and cataracts that point to careful management and follow-up. O-TB still remains a diagnostic challenge due to its rarity and changing clinical presentations. Early diagnosis and identification, presently mainly through imaging and histopathological examination, is important for the management. This review shows the effectiveness of ATT in the treatment of O-TB but also brings out the need for better diagnostic facilities and uniformity in treatment protocols so that complications can be prevented and outcomes improved. Future studies must be directed toward the development of more sensitive diagnostic tools and the elucidation of immune responses in O-TB guiding better clinical practice.

Orbital giant cell myositis is an unusual and potentially lethal cause of bilateral ophthalmoplegia - A case report and literature review

We present a case of orbital giant cell myositis (OGCM), presenting with bilateral subacute progressive ophthalmoplegia and optic nerve dysfunction. An early extraocular muscle biopsy confirmed the diagnosis and guided appropriate management. Comprehensive investigation excluded any underlying systemic disease, including myocarditis. Twenty two months after presentation, the patient remains well on azathioprine with complete resolution of orbital signs.