A 54-year-old white woman was referred for treatment with a diagnosis of presumed ARN in her right eye. There was no other relevant medical history. Her best-corrected visual acuity (BCVA) was 20/200 OD, 20/20 OS. On examination, the right eye had panuveitis with retinal necrosis and associated arteritis. There was also a relative afferent pupillary defect in the right eye. The left eye was unaffected. Vitreous biopsy confirmed herpes simplex virus–associated ARN by polymerase chain reaction. She began taking 10 mg/kg of intravenous acyclovir 3 times per day for 7 days followed by 500 mg of oral valacyclovir 3 times per day for 3 months. Four months later, the right eye became phthisical owing to persistent inflammation despite topical corticosteroids. Ten months later, the right eye was no longer inflamed but she had increasingly blurred vision and mild discomfort in her left eye. Her BCVA was 20/40 OS. Anterior segment examination revealed a white eye with mild inflammation and a cataract. There was minimal vitritis, and fundoscopy revealed disc swelling with multiple deep pale lesions throughout the fundus (Figure 1A). Fluorescein angiography showed early hyperfluorescensce of the choroidal lesions with late staining accompanied by perivascular and optic disc leakage of dye (Figure 1B). A vitreous biopsy was performed and was negative for herpes simplex virus, Varicella zoster virus, cytomegalovirus, and Epstein-Barr virus. The sensitivity for detection of virus by polymerase chain reaction in ARN at our institution was 87.5%.3 With suspicion of atypical presentation of bilateral ARN, she started taking 500 mg of oral valacyclovir 3 times per day and 40 mg of prednisolone once per day. Her BCVA improved to 20/20 OS. During the next 12 months, her visual acuity diminished to 20/40, partly owing to a cataract that was removed with a perioperative intravitreal triamcinolone injection. This did not improve her vision, and her condition continued to deteriorate, with BCVA reducing to 20/200 OS owing to macular involvement (Figure 1C). The choroiditis eventually left pale white scars with associated optic neuropathy (Figure 1D). On the final follow-up, the left eye was phthisical and she had no light perception visual acuity.