this 34-year - old man had progressive visual loss in the left eye of 2 months . automated visual fields were symmetrically normal . after seeking a second opinion 14 days later , best - corrected visual acuity ( bcva ) of the left eye was 20/100 ( 6/30 ) with diffuse disc elevation and peripapillary nerve fiber hemorrhage ( fig . optical coherence tomography ( oct ) demonstrated optic nerve head swelling and thickening ( fig . visual acuity was normal in the right eye with negative findings by 90-diopter slit - lamp exam , visual acuity , oct , and fluorescein angiography . detailed medical history was positive for a cough productive of clear sputum of recent duration , nonsmoking status , no exposure to cats , no ingestion of raw meat , and no extramarital relations . physical exam and infectious workup were essentially negative ( hiv , vdrl , borrelia burgdorferi , brucella , angiotensin - converting enzyme ) including chest radiograph and chest ct . ten days after the initial consult , bcva deteriorated further to 20/200 ( 6/60 ) in the left eye with increased disc swelling . he was started on treatment for presumed optic disc tuberculoma consisting of 2 months of rifampin , isoniazid , pyrazinamide , and ethambutol ( respective doses : 150 , 75 , 400 , and 275 mg ) followed by 4 months of rifampin and isoniazid . one week after initiation of quadruple antituberculous therapy , vision improved to 20/30 ( 6/9 ) with decreased disc swelling . bcva in the left eye was 20/20 ( 6/6 ) 2 weeks after initiation of therapy with a marked decrease in both disc elevation ( fig . 4 months after initiation of therapy , visual fields were unchanged . at the last follow - up optic nerve tuberculomas are rarely reported [ 1 , 2 , 3 , 4 , 5 , 6 ] , and their natural history , prognosis , and duration of required treatment remain unclear . davis et al .   gathered a large series of optic disc tuberculosis in order to delineate the progress of the disease and propose the most authoritative therapeutic regimen . in this analysis of 62 eyes from 49 patients with tuberculous optic neuropathy , papillitis was present in 51.6% , neuroretinitis in 14.5% , and optic nerve tubercle in 11.3% , with uveitis absent in 11.3% and extraocular tuberculosis absent in 63.3% of patients . in our case , an index of suspicion is required to diagnose ocular tuberculosis when all other systemic investigations are negative , especially in this part of the world where tuberculosis is endemic . isolated optic disc tuberculosis [ 1 , 2 , 3 , 4 , 5 , 6 ] , similar to isolated choroidal   or ciliary body   tuberculosis , can be the presenting form of tuberculosis in immunocompetent subjects without extraocular clinical signs or symptoms . positive ppd skin test and rapid response to antimycobacterial therapy confirm the clinical diagnosis of presumed ocular tuberculosis .