An otherwise healthy young man presents with bilateral CRVO as the first sign of hyperviscosity syndrome in the setting of new multiple myeloma.

Purpose: To report a case of bilateral central retinal vein occlusion as the presenting feature of new onset multiple myeloma in an otherwise healthy man.

Methods: A 44-year-old man presented with painless visual changes in his left eye. Ophthalmic examination revealed what appeared to be bilateral central retinal vein occlusion and hematologic assessment resulted in the diagnosis of immunoglobulin G multiple myeloma.

Results: Initial management was plasma exchange followed by a chemotherapy regimen of cyclophosphamide, bortezomib, and dexamethasone, and subsequent plans for bone marrow transplant.

Conclusion: Hyperviscosity syndrome seems similar to central retinal vein occlusion and may be associated with systemic conditions such as diabetes and atherosclerosis; however, alternative etiologies should be considered in young otherwise healthy individuals. This case underscores the need for diligent and thorough investigations for less common systemic conditions associated with retinal vein occlusions by primary care ophthalmologists.