Approach to tubercular disc edema

This is an open access article distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as the author is credited and the new creations are licensed under the identical terms. sub retinal fluid treated with intra vitreal bevacizumab. Indian J Ophthalmol 2016;64:546‑7. 2. Dave VP, Pappuru RR. An unusual presentation of non arteritic ischemic optic neuropathy with sub retinal fluid treated with intra vitreal bevacizumab. Approach to tubercular disc edema Sir, We read with interest, the brief communication entitled, " A case of subretinal tubercular abscess presenting as disc edema " by Shetty et al. After going through the article, we would like to highlight certain points in the management of disc edema, especially in an Indian setting. Tuberculosis (TB) is a great masquerade and can affect virtually any part of human body. Ocular TB, which can involve any segment of the eye, develops either from direct invasion by bacteria or from hypersensitivity reaction. Tuberculous optic neuropathy can manifest as papillitis, neuroretinitis, or optic nerve tubercle; of this, the most common manifestation is papillitis. Diagnosing extrapulmonary TB like ocular TB is a challenge due to difficulty in obtaining specimen for tests; hence, high index of suspicion is important in some appropriate clinical settings. TB should be considered as an important differential in an immunocompetent patient with optic neuritis even if he is asymptomatic otherwise. [3] In a young male presenting with gradual, painful diminution of vision over 25 days, the authors considered idiopathic optic neuritis as the probable diagnosis and administered intravenous methylprednisolone. However, in cases of disc edema, infectious, noninfectious, and autoimmune conditions such as neuroretinitis, multiple sclerosis (MS), diabetes, neoplasia, sarcoidosis, systemic lupus erythematosus, and rheumatoid arthritis should be kept in mind, and once we are sure of their absence, it should be labeled idiopathic. In the case described in this article, magnetic resonance imaging (MRI) brain and orbit as baseline investigation for the optic neuritis would have been appropriate. At T2‑weighted MRI, acute optic neuritis manifests as hyperintense signal in enlarged, enhancing optic nerve whereas chronic optic neuritis manifests as hypeintense signal in an atrophic, nonenhancing optic nerve. It would not only have ruled out conditions such as MS (an important differential) but also have given an idea about possible tubercular involvement of optic nerve as well as brain. Lifetime risk …