Tuberculosis caused by Mycobacterium tuberculosis is the leading infectious killer posing a major public health threat. The clinical manifestations of ocular tuberculosis are highly heterogeneous. Currently, the diagnosis of ocular tuberculosis still heavily relies on comprehensive clinical judgment and response to anti-tuberculosis therapy. Tuberculosis-specific T-cell detection quantifies the intensity of antigen-specific T-cell responses, providing indirect evidence for the diagnosis of tuberculosis infection. It has become a key auxiliary examination in the diagnosis and management of ocular tuberculosis but must be closely integrated with clinical manifestations and imaging features. A positive result suggests the involvement of a tuberculous immune response but cannot alone confirm a diagnosis of ocular tuberculosis. Future efforts should integrate T-SPOT.TB testing with other diagnostic tools, standardize diagnostic procedures, and explore the mechanisms linking T-cell subset functions with the intraocular immune microenvironment. Further elucidation of the relationship between T-cell responses and ocular tuberculosis phenotypes will help advance personalized treatment.