Incidence and Risk Factors of Ophthalmic Nerve Palsy in Patients With Tuberculous Meningitis: A Retrospective Study and Literature Review

Abstract Background Tuberculous meningitis (TBM) can lead to ophthalmic nerve palsy (ONP), a severe neurological complication. This study aims to evaluates the incidence and risk factors for ONP in TBM patients. Methods This retrospective study included 250 TBM patients from the Shanghai Public Health Clinical Center (2013-2022). Clinical and imaging data were analyzed, with logistic regression identifying risk factors for ONP. Results ONP occurred in 6.8% (17/250) of TBM patients. Those with ONP had higher intracranial pressure (ICP) (257.69 ± 68.12 mmH2O vs 191.65 ± 91.58 mmH2O; P = 0.012), cerebrospinal fluid protein levels, and a higher prevalence of tuberculomas (29.4% vs 10.7%; P = 0.039). Logistic regression identified pre-treatment ICP, CD4 percentage, and tuberculomas as significant risk factors. Linezolid use was a protective factor for ONP recovery. Conclusions Six point eight percent (17/250) of patients with TBM developed ONP as a complication. ICP, CD4 counts, and tuberculomas are key predictors. Linezolid shows potential as a therapeutic agent for improving outcomes in TBM patients with neurological complications, warranting further study. Graphical Abstract Graphical Abstract This study found a 6.8% incidence of ophthalmic nerve palsy (ONP) in tuberculous meningitis patients. Key risk factors include high intracranial pressure, tuberculomas, and CD4 percentages. Linezolid use was associated with improved ONP recovery, suggesting potential therapeutic benefits.