Epidemiology and Clinical Characteristics of Ocular Tuberculosis in the United States, 1993-2019.

Background: Data regarding ocular tuberculosis (OTB) in the United States have not been previously reported. We evaluated trends of OTB compared with other extrapulmonary TB (EPTB).

Methods: We estimated the proportion of all EPTB cases (with or without concurrent pulmonary involvement) with OTB reported to the National Tuberculosis Surveillance System during 1993-2019. We compared demographics and clinical characteristics of people with OTB and other EPTB during 2010-2019. values were calculated by chi-square test for categorical variables and Kruskal-Wallis for continuous variables.

Results: During 1993-2019, 1766 OTB cases were reported, representing 1.6% of 109 834 all EPTB cases: 200 (0.5% of 37 167) during 1993-1999, 395 (1.0% of 41 715) during 2000-2009, and 1171 (3.8% of 30 952) during 2010-2019. In contrast to persons with other EPTB, persons with OTB were older (median, 48 vs 44 years; < .01), more likely to be US-born (35% vs 28%; < .01), more likely to have diabetes (17% vs 13%; < .01), and less likely to have HIV (1% vs 8%; < .01). OTB was less likely to be laboratory confirmed (5% vs 75%; < .01), but patients were more likely to be tested by interferon gamma release assay (IGRA; 84% vs 56%; < .01) and to be IGRA positive (96% vs 80%; < .01).

Conclusions: Reported OTB increased during 1993-2019 despite decreasing TB, including EPTB; the largest increase occurred during 2010-2019. OTB was rarely laboratory confirmed and was primarily diagnosed in conjunction with IGRA results. More research is needed to understand the epidemiology of OTB to inform clinical and diagnostic practices.