Answer
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It was felt the patient’s ocular signs were most suggestive of sarcoidosis; however, in view of his ethnic origin tuberculosis was also considered. His Tuberculin Heaf test result was grade 3, and chest *x* ray showed left upper zone shadowing. Bronchial washings grew acid fast bacilli. He was commenced on anti-tuberculous chemotherapy. He has completed treatment and his eye symptoms have resolved.

Retinal vasculitis associated with tuberculoprotein hypersensitivity is not new.1 Eales’ disease is a syndrome of retinal and vitreous haemorrhage and was first described in 1880.2 Although multiple theories of origin have been proposed, its cause continues to be unknown and its diagnosis relies on exclusion of other causes of retinal vasculopathy.

Eales’ disease can be associated with current or previous *Mycobacterium tuberculosis* infection. It most commonly affects healthy men in their 20s and 30s, and is prevalent in India.3 Treatment is usually with corticosteroids. Complications include retinal detachment. Although presentation in this manner is more common in the Indian subcontinent, because of ever increasing population migration this is a diagnosis all respiratory physicians should be aware of.

*From the question on page [520](http://thorax.bmj.com/lookup/volpage/62/520)* 

## REFERENCES

1.  **Renie W A**, Murphy R P, Anderson K C, *et al.* The evaluation of patients with Eales’ disease. Retina1983;3:243–8.
    
    [PubMed](http://thorax.bmj.com/lookup/external-ref?access_num=6675099&link_type=MED&atom=%2Fthoraxjnl%2F62%2F6%2F526.atom) 
    
    [Web of Science](http://thorax.bmj.com/lookup/external-ref?access_num=A1983SC18400001&link_type=ISI) 

2.  **Eales H**. Primary retinal hemorrhage in young men. Opthalmol Rev1882;1:41–6.
    
    

3.  **Helm C J**, Holland G N. Ocular tuberculosis. Surv Opthalmol1993;38:229–56.
    
    [CrossRef](http://thorax.bmj.com/lookup/external-ref?access_num=10.1016/0039-6257(93)90076-J&link_type=DOI) 
    
    [PubMed](http://thorax.bmj.com/lookup/external-ref?access_num=8310395&link_type=MED&atom=%2Fthoraxjnl%2F62%2F6%2F526.atom) 
    
    [Web of Science](http://thorax.bmj.com/lookup/external-ref?access_num=A1993ML74500001&link_type=ISI)