Abstract:

Tuberculous uveitis (TBU) is the most common manifestation of intraocular tuberculosis, with an increasing global incidence, and represents a major infectious cause of visual impairment and blindness in clinical settings. The diagnosis and treatment of TBU pose substantial challenges, chiefly owing to the incomplete understanding of its complex pathogenesis. Debate has long persisted as to whether TBU results from direct infection of intraocular tissues by Mycobacterium tuberculosis (MTB), an immune hypersensitivity reaction triggered by distant infectious foci, or a molecular mimicry mechanism involving autoimmunity. In recent years, advances in immunology and molecular biology have greatly deepened our understanding of TBU pathogenesis. It is now widely accepted that the pathogenesis of TBU cannot be explained by a single mechanism, but rather involves a dynamic interplay among the pathogen, host immune response, and ocular microenvironment. This review aims to systematically elaborate the historical discovery and conceptual evolution of TBU, thoroughly investigate diverse pathogenesis hypotheses and supporting evidence, and summarize the currently accepted integrated view of its pathogenesis. Emphasis is placed on the latest research advances in host genetic susceptibility, key immune cell subsets (e.g., Th1/Th17 cells), cytokine networks, and MTB virulence factors, so as to provide novel perspectives and directions for future basic research and clinical practice.

Key words: Uveitis, Tuberculosis, Immune tolerance, Review literature as topic