PATHOPHYSIOLOGY/DEFINITION
Ocular involvement from TB can either occur as a primary active infection or a secondary infection from a distant site, usually through hematogenous spread.
The conjunctiva, cornea, and sclera are sites of primary ocular involvement.
TB infection happens in 4 stages: the initial macrophage response, the growth stage, the immune control stage, and the lung cavitation stage.
These four stages happen over roughly one month.
On microscopic level the tuberculous granuloma is an organized aggregation of immune cells and debris.
It contains macrophages that have undergone morphological change into epithelioid cells which form into zipper-like arrays around the necrotic centre.
They retain the ability to phagocytise mycobacteria.