患者，男，64岁，近期确诊为肺结核，最初给予抗结核药物治疗，出现左眼疼痛，视力减退。眼部检查显示左眼疼痛并盲，严重感染，核素成像显示眼球后壁增厚和视神经疾病。右眼眼底中周边出现脉络膜细胞瘤。建议左眼球剜除但患者未同意。疑似眼部结核确诊。虽然患者左眼有肺结核感染并盲，但通过抗结核药物脉络膜结核瘤逐渐缓解。该病例表明眼部结核侵入性发展可以导致视力迅速减退。眼部结核是很难确诊的，特别是对于严重感染的病例。

A 64-year-old man who was recently diagnosed with pulmonary tuberculosis, for which anti-tuberculous regimens was initiated, presented with painful and progressive reduced vision of the left eye. Ocular examination showed a painful blind left eye, which was severely inflamed, with radio imaging evidence of posterior wall thickening and optic neuropathy. There was a choroidal tuberculoma located at mid-periphery fundus of the right eye. Left eye enucleation was advised, but declined. Diagnosis of presumed ocular tuberculosis was made. Although the left eye was phthisical and blind, the choroidal tuberculoma resolved gradually with anti-tuberculous regimens. This case showed an aggressive presentation of ocular tuberculosis which resulted in rapid loss of vision. The diagnosis was challenging especially in the context of a severely inflamed eye.