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.