A 28-year-old man who underwent gastric bypass surgery 2 months prior presented with acute blurred vision and vomiting. His afferent visual function was normal. Fundus examination revealed hyperemic optic discs, telangiectasias, thickened peripapillary retinal nerve fiber layer, and perivenous hemorrhages in both eyes (A, B). Brain magnetic resonance imaging showed bilateral and symmetric involvement of the floor of the third ventricle, dorsomedial thalamus, mamillary bodies, periaqueductal gray matter, and tectal plate, all typical of Wernicke’s encephalopathy. Fundus abnormalities improved 1 month after thiamine supplementation (C, D). Fundus findings are unusual but important to recognize to avoid diagnostic delay (Magnified version of Figure A-D is available online at www.aaojournal.org).