Tuberculous orbital apex syndromes

Br J Ophthalmol. 2008 Nov;92(11):1511-7. doi: 10.1136/bjo.2008.138974. Epub 2008 Jul 9.


Aims: To describe the clinical and radiological features of orbital apex syndromes caused by presumed tuberculosis (TB).

Methods: A review of the discharge summaries of all patients seen in the Medical Eye Unit (MEU), St Thomas' Hospital between 1975 and 2006 identified seven patients with a diagnosis of orbital apex syndrome or optic neuropathy attributable to TB. Case notes and radiology were reviewed retrospectively for each patient.

Results: All of the patients were born outside the UK and were HIV-negative. Four presented during 2005-6. Six of the seven patients presented with a visual acuity (VA) of less than counting fingers (CF), but all achieved a VA of 6/9 or better after a median 3 weeks of treatment with antituberculous treatment and systemic corticosteroids. All patients had constitutional symptoms. Chest x ray and CSF were normal in each case, but MRI was abnormal in six.

Conclusions: We report a recent cluster of tuberculous orbital apex syndromes, in the context of an increasing incidence of TB in the UK. The condition is difficult to diagnose, but the combination of high-dose corticosteroids and anti-TB medication was rapidly effective and achieved a good outcome in all cases.

Publication types

  • Case Reports

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Antitubercular Agents / therapeutic use
  • Combined Modality Therapy
  • Female
  • Follow-Up Studies
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Optic Nerve Diseases / diagnosis
  • Optic Nerve Diseases / drug therapy
  • Optic Nerve Diseases / etiology*
  • Retrospective Studies
  • Syndrome
  • Treatment Outcome
  • Tuberculosis, Ocular / complications*
  • Tuberculosis, Ocular / diagnosis
  • Tuberculosis, Ocular / drug therapy


  • Adrenal Cortex Hormones
  • Antitubercular Agents