Background: Ocular tuberculosis (TB) is a rare manifestation of extrapulmonary tuberculosis that can involve any ocular structure, leading to significant morbidity if not diagnosed and treated early.

Case Presentation: We report a case of a 42-year-old woman presenting with granulomatous anterior uveitis and choroidal tubercles without systemic TB evidence. Diagnosis was supported by positive Mantoux test, interferon-gamma release assay, ocular imaging findings, and clinical response to anti-tubercular therapy. The patient was successfully treated with a standard six-month anti-TB regimen and adjunctive corticosteroids, leading to complete resolution of ocular lesions and restoration of vision.

Conclusion: Ocular TB remains a diagnostic challenge and demands a high index of suspicion, especially in TB-endemic areas. Early recognition, appropriate anti-tubercular therapy, and multidisciplinary care are critical to prevent irreversible vision loss.