New BTS Clinical Statement on Ocular TB

The BTS Clinical Statement for the diagnosis and management of Ocular Tuberculosis has today been published in the open access journal BMJ Open Respiratory Research.

Ocular Tuberculosis (TB) is a form of extrapulmonary TB which can cause damage to intraocular tissues and lead to loss of vision. Currently available literature lacks high quality evidence to inform clinical practice and explain the mechanisms of the disease, preventing the development of a full guideline.

Both physicians and ophthalmologists dealing with ocular TB face a series of dilemmas, diagnosis can be hindered by other ocular diseases presenting the same characteristics, which can make a diagnosis of active or latent TB more complex. Some drugs conventionally used to treat TB might be oculotoxic (harmful to the eye) and therefore not appropriate to use.

This Clinical Statement was developed by TB and Ophthalmic specialists to improve and standardise patient care and support those managing patients with this disease, whether confirmed or suspected. In its pages, it outlines the current understanding of disease pathogenesis, diagnosis and management in adults, but it also provides consensus points with the currently available data and best practices that can be applied in the clinic.

Professor Onn Min Kon, Consultant Respiratory Physician at Imperial College Healthcare NHS Trust and chair of the Clinical Statement group, said:

‘‘Ocular Tuberculosis can be a significant and serious manifestation of active Tuberculosis. However it is difficult to diagnose and has historically been investigated and managed with a variety of approaches.

“The British Thoracic Society in collaboration with the Royal College of Ophthalmologists has brought together TB and ophthalmology specialists who reviewed the available evidence and who then developed an agreed and pragmatic approach for the diagnosis and management of Ocular Tuberculosis.

“We believe that standardising the multidisciplinary approach to Ocular TB will improve the management of this complex and difficult presentation of TB. 

“This statement also highlighted the lack of high quality evidence in Ocular TB and the need to provide a more robust evidence base by research in order to bring more clarity in our approach to this disease.”

Dr Nick Beare, Consultant Ophthalmologist at the Royal Liverpool University Hospital, and member of Clinical Statement group, said:

“Ocular Tuberculosis is a difficult condition to diagnose and treat, involving teams across different specialities. There may be direct infection in the eye or ocular immunological reaction to TB infection elsewhere. So this consensus statement developed by respiratory and ophthalmology specialists is especially welcome.

“It has been a privilege and a pleasure to represent the Royal College of Ophthalmologists in the development of this Clinical Statement alongside fellow ophthalmologists and respiratory physicians in a process undertaken by the British Thoracic Society. Careful consideration of the available evidence has led to clinical practice points and agreed best practice. In developing the consensus statement the committee noted a paucity of relevant evidence, and much of the available evidence is ambiguous and inconclusive due to quality issues with the clinical studies.

“We have highlighted areas for further research which we hope will encourage quality research in Ocular TB in the future.”

An interview with Professor Onn Min Kon offering more insight into the Statement is available on Respiratory Futures.