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Objective: To find out the association of lateral rectus palsy in patients with tuberculous meningitis (TBM). Material and Methods: This study was conducted at Department of Neurology, Lady Reading Hospital, Peshawar from January 2008 to December 2009 on 43 diagnosed patients of TBM. The diagnosis was made on the basis of history, clinical presentation, laboratory and radiological findings. Patients of tuberculous meningitis with or without intracranial tuberculomas or having any extra cranial tuberculosis were included while cases presenting with similar clinical picture but having non tuberculous CNS pathology were excluded from the study. Results: Out of 43 patients, 27 (62.8%) patients were females and 16 (37.3) were males. The age range was from 7 years to 65 years with mean age of 36 years. Out of 43 patients, 11 (25.58%) patients were assigned stage I, 23 (53.48%) stage II and 9 (20.93%) stage III, according to Medical Research Council classification for tuberculous meningitis. Fourteen out of 43 (32.6%) were found to have unilateral or bilateral lateral rectus palsy. Conclusion: The presence of recent onset lateral rectus palsy is an important sign towards the diagnosis of TBM. However more studies are needed to establish the diagnostic value of lateral rectus palsy in diagnosing TBM. [ABSTRACT FROM AUTHOR]