Ocular Tuberculosis Presenting As Recurrent Corneal Ulceration With Corneal Perforation: A Case Report

To report a rare case of ocular tuberculosis presenting as recurrent corneal inflammation progressing to corneal perforation, initially misdiagnosed as infectious endophthalmitis. This case highlights the importance of thorough longitudinal anamnesis and consideration of tuberculosis as an underlying etiology in endemic regions when managing atypical or recurrent corneal ulcers.

A tertiary eye care setting in Indonesia, a tuberculosis-endemic country, involving multidisciplinary ophthalmic management including emergency corneal surgery and systemic infectious disease evaluation.

A patient first presented in March 2025 with acute painful red eye, blurred vision, and tearing. Ocular ultrasonography revealed posterior choroidal detachment, retinal detachment, and corneal perforation with severe intraocular inflammation, raising suspicion of endophthalmitis. Upon referral, intraocular pressure was found to have suddenly decreased, consistent with choroidal detachment. Emergency corneal patch graft surgery was performed due to corneal perforation, followed by initial clinical improvement. In August 2025, the patient experienced recurrent ocular pain and foreign body sensation. Examination suggested recurrent corneal ulceration with persistent inflammation. Despite topical therapy, inflammation persisted and only partially improved with systemic corticosteroids. Further detailed anamnesis revealed a history of recurrent red eye since 2021 with spontaneous
remissions. Interferon-gamma release assay (IGRA) was positive, leading to a diagnosis of ocular tuberculosis after approximately four years of symptoms. Anti-tuberculosis therapy was initiated, resulting in significant and sustained clinical improvement.

Ocular tuberculosis, though rare, can present as recurrent marginal corneal ulceration and progress to corneal perforation. In tuberculosis-endemic regions, clinicians should maintain a high index of suspicion for ocular TB in cases of atypical, recurrent, or treatment-resistant corneal inflammation.
Comprehensive anamnesis and early systemic evaluation are essential to prevent delayed diagnosis and severe ocular complications.