A 60-year-old woman with a history of recurrent headaches and blurred vision but otherwise healthy presented to an ophthalmologist with bilateral optic disc edema. Intravenous methylprednisonlone was administered because of a concern for optic neuritis. The patient’s vision declined to hand motions level in both eyes and a subsequent evaluation revealed bilateral acute retinal necrosis with bilateral central retinal artery occlusions. Aqueous humor polymerase chain reaction analysis was positive for herpes simplex virus (HSV), establishing a diagnosis of HSV-associated bilateral acute retinal necrosis (ARN) and meningitis. Central retinal artery occlusion (CRAO) has rarely been reported in association with ARN and the particularly fulminant course with bilateral CRAO in association with ARN has not been previously reported. Our patient’s disease course emphasizes the importance of careful peripheral examination in patients with presumptive optic neuritis, judicious use of systemic corticosteroid in this context, and the retinal vaso-obliterative findings that may be observed in the pathogenesis of ARN.