Orbital tuberculosis: a review of the literature

Orbit. 2008;27(4):267-77. doi: 10.1080/01676830802225152.


Purpose: To provide an up-to-date review of the clinical presentations, investigations, and management of orbital tuberculosis (OTB).

Methods: Systematic review of the literature concerning OTB, limiting the results to English-language peer-reviewed journals.

Results: Seventy-nine patients from 39 publications were identified as cases of OTB. The condition presents in one of five forms: classical periostitis; orbital soft tissue tuberculoma or cold abscess, with no bony involvement; OTB with bony involvement; spread from the paranasal sinuses; and tuberculous dacryoadenitis. The ocular adnexa, including the nasolacrimal system and overlying skin, may also be involved.

Conclusions: Diagnosis can be difficult and may necessitate an orbital biopsy, in which acid-fast bacilli (AFB) and characteristic histopathology may be seen. Growth of Mycobacterium tuberculosis (mTB) from such a specimen remains the gold standard for diagnosis. Ancillary investigations include tuberculin skin tests and chest radiography, but more recently alternatives such as whole blood interferon-gamma immunological tests and PCR-based tests of pathological specimens have proven useful. The management of OTB is complex, requiring a stringent public health strategy and high levels of patient adherence, combined with long courses of multiple anti-tuberculous medications. The interaction of the human immunodeficiency virus (HIV) with TB may further complicate management.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antitubercular Agents / therapeutic use
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Interferon-gamma / blood
  • Male
  • Middle Aged
  • Mycobacterium tuberculosis / isolation & purification
  • Orbital Diseases / diagnosis*
  • Orbital Diseases / drug therapy
  • Orbital Diseases / epidemiology
  • Orbital Diseases / microbiology
  • Radiography, Thoracic
  • Risk Factors
  • Tomography, X-Ray Computed
  • Tuberculin Test
  • Tuberculosis, Ocular / diagnosis*
  • Tuberculosis, Ocular / drug therapy
  • Tuberculosis, Ocular / epidemiology
  • Tuberculosis, Ocular / microbiology


  • Antitubercular Agents
  • Interferon-gamma