Korean J Ophthalmol Vol.22, No.3, 2008 Fig. 1. Chest X-ray taken at initial presentation (a year before eyelid drooping developed). Diffuse effusion with pleural thickening was observed in the left side. Other cranial nerves were normal and the uncorrected visual acuity was 20/20 in the right eye and 20/20 in the left. Accordingly, it was suspected that his tuberculosis was resistant to isoniazid and rifampin, and thus, pyrazinamide and ethambutol were added; dexamethasone was also injected to reduce brain swelling. After one month on this medication, no restriction in extraocular movement was apparent (Fig. 4b), his diplopia had also disappeared, and drooping of the left upper eyelid was much improved (MRD: +4 (OD), +3 (OS)). Moreover, the choroidal tuberculous granuloma had Table 1. Ptosis examination (at second presentation) OD OS MRD* +4 -1 LF† 11 mm 6 mm * MRD=Marginal reflex distance; † LF=Levator muscle function Table 2. Ptosis examination (after three added treatment) months of MRD LF OD +4 15 mm OS +2.5 11 mm reduced slightly to 1/2 the optic disc. After 3 months on this treatment ptosis of the left upper eyelid (MRD: +4 (OD), +2.5 (OS), LF: 15 mm (OD), 11 mm (OS)) improved (Table 2) and the choroidal tuberculous granuloma further decreased (Fig. 3b). However, he complained that he could not see the left eyes of people on television, and thus, visual field testing was conducted (Humphrey field analyzer 2: program C30-2), and a right wedge-shaped sector homonymous visual field defect due to lesions of the left lateral geniculate nucleus (Fig. 5). D iscussio n Tuberculous meningitis is a feared manifestation of tuberculous infection, because it is often difficult to diagnosis, requires a long course of therapy, and is associated with significant morbidity and mortality. Its most common signs and symptoms include fever, headache, changes in mentation, and meningismus in most patients. Other signs include focal neurologic deficits, such as, cranial nerve palsies, paresis, seizures, and diminished cognition.2 Fig. 2. Brain MRI (a) At initial presentation, This image shows strong enhancement of leptomeninges at the basal cistern and multiple tuberculous granuloma at the brain base. (b) The size and number of the tuberculous granuloma had increased at second presentation. 202