A 15-year-old girl presented with a history of painless, progressive swelling on the left side of the face of 2 months duration. She had a history of drainage of abscesses in the neck and arm, following which she was on antitubercular therapy for 3 months, which she eventually discontinued abruptly. On examination, fullness along the left lateral orbital rim with ptosis (especially laterally) and limitation of abduction in the left eye were noted (Figure 1A). Her BCVA was 6/6 in both eyes. Slit lamp, fundus and intraocular pressure evaluations were normal in both eyes. Systemic examination revealed scars in the supraclavicular region and arm (Figure 1B). Computed tomography (CT) of the orbits revealed a well-defined lytic lesion along the lateral orbital wall with central sequestrum and associated peripherally enhancing abscess with minimal periosteal reaction suggestive of osteomyelitis (Figure 1C). Laboratory investigations revealed an increased erythrocyte sedimentation rate (ESR) of 60 mm/h, a positive Mantoux test and a normal chest X-ray. The abscess was drained, and the wall of the abscess cavity was sent for microbiological and histopathological examination. Chronic granulomatous inflammation with caseation necrosis was seen on histopathology (Figure 1D). Although the Gomori methenamine silver (GMS) staining, acid fast bacilli (AFB) staining and culture for Mycobacterium tuberculosis (MTb) were negative, PCR was positive for MTb. She was started on a second-line antitubercular therapy (ATT) which included daily intramuscular injections of streptomycin 0.75 mg for 6 months, ethionamide tablet 250 mg twice daily, cycloserine tablet 250 mg twice daily and ofloxacin tablet 400 mg once daily for 1.5 years. At the last follow-up, the lesion at the lateral orbital rim had resolved completely.