Rare ophthalmic complication of tuberculosis meningitis: tuberculosis orbital apex syndrome

Orbital apex syndrome (OAS) is characterised as dysfunction of the optic nerve, oculomotor nerve, trochlear nerve, abducens nerve and ophthalmic branch of the trigeminal nerve (V1) and has a diversity of aetiologies, including infectious, inflammatory and neoplastic causes. Tuberculosis OAS, a rare manifestation of extrapulmonary tuberculosis, presents a considerable diagnostic challenge because of both its rarity—particularly in non-tuberculosis-endemic countries—and its localisation to this anatomically complex site. In this case report, we present a woman in her mid-60s, living in the midwestern USA, who presented with OAS. Her diagnosis of tuberculosis meningitis was established by dural biopsy demonstrating necrotising granulomas and acid-fast bacilli. After 2 months of modified anti-tuberculosis therapy, she experienced improvement in her extraocular motility and visual acuity.