Epithelial Keratitis Secondary to Presumed Ocular Tuberculosis: A Report of Two Cases

ABSTRACT: This report presents two rare cases of presumed epithelial keratitis secondary to ocular tuberculosis (TB), highlighting an unusual clinical presentation that may be underrecognized. Two male patients from a TB-endemic region presented with unilateral, chronic epithelial keratitis in a semicircular pattern, with mild anterior stromal infiltration and reduced corneal sensitivity. Both were unresponsive to standard topical and systemic treatments including antivirals and corticosteroids. Diagnostic evaluation included Mantoux testing and systemic screening. Mantoux tests were positive in both patients, and one exhibited radiological evidence of latent pulmonary TB. Initiation of systemic antituberculosis therapy led to complete epithelial healing within 30 to 60 days in both cases. Each patient developed localized stromal scarring without neovascularization, and no recurrence was observed during follow-up periods of 6 months and 4 years, respectively. The absence of neovascularization, despite the chronicity of keratitis, may be a distinguishing clinical feature from herpetic keratitis. These cases illustrate a potentially underdiagnosed manifestation of ocular TB and suggest that tuberculosis should be considered in the differential diagnosis of refractory epithelial keratitis, especially in endemic regions or in patients with epidemiological risk factors. A Mantoux test with induration of 10 mm or greater, even in BCG-vaccinated individuals, may support the diagnosis in the appropriate clinical context. Antituberculosis therapy may be both therapeutic and diagnostic in such cases.