Global Perspectives on Ocular Tuberculosis: A Systematic Review of Epidemiology and Clinical-Diagnostic Trends (2010-2025)

Purpose: To evaluate global epidemiological trends, clinical phenotypes, and diagnostic criteria for ocular tuberculosis (OTB) from 2010 to 2025. Methods: This systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and analyzed peer-reviewed studies reporting OTB epidemiology, diagnostics, and clinical manifestations. Eleven studies from high-burden regions (India, Pakistan, China, Malaysia) and the USA were included after database searches and application of eligibility criteria. Due to heterogeneity in reporting, meta-analysis could not be performed. Results: Predominant clinical phenotypes included retinal vasculitis (33.3–64.3%) and panuveitis (8.7–51.4%), with choroiditis variants (e.g., serpiginous-like choroiditis) more common in Asian cohorts. Diagnostic criteria typically combined suggestive clinical signs (often using Standardization of Uveitis Nomenclature criteria) with supportive tests: tuberculin skin test positivity ranged from 61.5% to 100%, interferon-gamma release assay from 71.2% to 100%, and polymerase chain reaction on ocular fluids from 9.6% to 81.8%. Anti-tubercular therapy response rates of 80–100% supported diagnosis, while novel markers such as interleukin-17 showed diagnostic promise. Conclusion: Significant heterogeneity in diagnostic reporting and a regional bias toward high-burden areas limited generalizability. Standardized protocols (e.g., Collaborative Ocular Tuberculosis Study and British Thoracic Society guidelines) along with advanced diagnostics are needed to improve OTB diagnosis and management worldwide, though evidence from low-burden settings remains underrepresented.