A 54-year-old man with no prior medical care presented with acute vision loss in the left eye. Visual acuity was hand motion and blood pressure were 220/136. Examination demonstrated severe disc and macular edema, retinal whitening, venous sheathing, and intraretinal hemorrhages (Panel A). Fluorescein angiography revealed venous leakage and non-perfusion (Panel B). The patient underwent empiric intravitreal foscarnet. After infectious/inflammatory etiologies were ruled out, he received 3 monthly intravitreal bevacizumab injections for presumed central retinal vein occlusion. At 3 months, there was complete resolution of sheathing (Panel C) but with persistent macular ischemia (Panel D) resulting in counting fingers vision.