A 56 year old woman with a history of exposure to tuberculosis presented with rapid visual loss following a prolonged period of malaise and intermittent headache. Despite clinical and ultrasonographic evidences of bilateral posterior scleritis, there were no other signs of ocular inflammation. Subsequent investigations confirmed a diagnosis of active tuberculosis. She was treated initially with quadruple anti-tuberculous therapy. The addition of pulsed intravenous methyl prednisolone was followed promptly by improvement in ocular symptoms with resolution of B scan abnormalities. This case demonstrates that posterior scleritis may present with minimal inflammatory signs, the importance of considering tuberculosis in the differential diagnosis of posterior scleritis and the role of additional steroid in the treatment of tuberculous scleritis.