Normal tension glaucoma as initial manifestation of Takayasu arteritis- an unknown entity.

Objective: To report an unusual manifestation of normal tension glaucoma(NTG) in a young female as presenting feature of Takayasu arteritis (TA).

Methods: We present a case of a 24-year-old woman who was initially diagnosed with NTG, with characteristic optic disc and retinal nerve fiber layer (RNFL) changes, and corresponding visual field defects. Further evaluation with CT angiography revealed that the patient had newly diagnosed TA.

Results: NTG was likely a manifestation of the underlying vasculitis. patient was initially started on oral prednisolone by the rheumatologist which was changed to steroid-sparing immunotherapy with methotrexate 15 mg once weekly and hydroxychloroquine 200 mg. The patient has been on regular follow-up for last one year with adequate IOP control and no progression of glaucomatous changes since presentation.

Conclusion: This case highlights the importance of comprehensive ophthalmic evaluation in patients with NTG and the need to consider systemic conditions, such as TA, as potential underlying cause in young female patients presenting with NTG.