Case Description: A 50-year-old female with history of biopsy proven pulmonary sarcoid 4-years prior not on immunotherapy. She presented with painless progressive subacute vision loss over several months. Visual acuity was 20/30 on right and 20/400 on left, cupped optic-discs bilaterally with temporal pallor on left. She was initially diagnosed with glaucoma as the etiology of the vision loss. MRI orbits showed large infiltrative enhancing mass within the optic chiasm extending to the prechiasmal optic nerves worse on the left. Laboratory investigations (blood and CSF) revealed very mild lymphocytic pleocytosis (CSF WBC 6), mildly elevated CSF protein, elevated serum chitotriosidase and IgG1. Serum and CSF Angiotensin converting enzyme, NMO and MOG antibody were normal. CSF cytology and flow cytometry were unrevealing. Biopsy was not attained due to location of the mass and risk of procedure related vision loss. Due to high clinical suspicion of neurosarcoidosis intravenous steroids was given followed by oral steroid taper. 2 week follow-up MRI revealed significant improvement in the enhancement. Visual improvement was noted subjectively and objectively. Multi-disciplinary team follow-ups with pulmonology, rheumatology and neuro-ophthalmology were established.