Abstract

Optic atrophy is an irreversible end stage of optic nerve damage and is frequently associated with serious intracranial pathology. Ocular manifestations often serve as early indicators of intracranial space occupying lesions (ICSOL), aiding in lesion localization and timely intervention. This case report describes a 9-year-old female who presented with gradually progressive, painless visual loss in the left eye accompanied by headache and systemic symptoms such as fever, weight loss, and seizures. Ophthalmic evaluation revealed relative afferent pupillary defect and optic atrophy in the affected eye, with disc pallor in the fellow eye. Neuroimaging demonstrated an ill-defined conglomerated lesion in the left parieto-occipital region with midline shift and leptomeningeal enhancement, suggestive of tuberculoma. Further investigations, including positive Mantoux test, cerebrospinal fluid analysis, and biopsy findings of necrotic brain parenchyma with giant cell granulomas, confirmed the diagnosis. The patient underwent decompressive craniotomy followed by anti-tubercular therapy and steroids. This report highlights tuberculoma as an uncommon but important cause of compressive optic neuropathy in children. Early recognition of ocular signs and prompt multidisciplinary management are crucial, as visual recovery is possible before the development of optic atrophy. Once optic atrophy is established, visual loss remains permanent.