a. What does the chest X-ray show?

b. What ocular signs may be present?

c. In what ways can treatment of this 
    condition affect the eyes?

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This is the chest x-ray of a 80 year-old woman with  weight loss.

a. What does the chest X-ray show?

There is multiple nodular opacities in the pulmonary parenchyma.
This is typical appearance of miliary tuberculosis (widespread 
dissemination of the infection following primary infection); it is 
most commonly seen in debilitated patients and children.

b. What ocular signs may be present?

Anterior segment:

• lupus vulgaris of the lids
• phlyctenular conjucntivitis
• keratitis
• scleritis
• granulomatous uveitis

Posterior segment:

• posterior uveitis
• chorioretinal granuloma

Neuro-ophthalmic:

• cranial palsies from basal TB meningitis

c. In what ways can treatment of this condition affect the eyes?

Toxic optic neuropathy can occur with ethambutol and isoniazid 
both of which are commonly used as first line treatment of tuberculosis. 

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