Interferon therapy for the treatment of hepatitis C may be associated with retinopathy and, rarely, vision loss. The pathogenesis of interferon-associated retinopathy is thought to be related to the deposition of immune complexes in the retinal vasculature, producing leukocyte infiltration and retinal ischemia. We present a patient with chronic hepatitis C who developed decreased visual acuity and retinal nerve fiber layer infarct while undergoing treatment with pegylated interferon and ribavirin. Case Report: A 46-year-old obese woman was referred to our office after testing positive for hepatitis C during a voluntary blood donation. Laboratory workup indicated a mild elevation of alanine aminotransferase (ALT), serum HCV-RNA by PCR of 2,096,000 copies/ml, and Genotype 1b. Liver biopsy revealed a Knodell Score of 6 with fibrosis. Treatment was initiated with pegylated interferon alpha 2-b, 150 mcg weekly, and ribavirin, 1000 mg orally, daily. By week twelve, HCV-RNA by PCR was undetectable and ALT was normal. The patient initially had only minor systemic complaints but during week thirteen she described a halo formation in the superior lateral aspect of her visual field in only the left eye (OS). Dilated fundoscopic exam detected a retinal nerve fiber layer infarct at the posterior pole OS. Treatment was immediately stopped. Over the next six months the patients retinal findings resolved completely and although her visual field defect improved she continued to describe a small defect in the left superior lateral visual field. Repeat HCV-RNA by PCR was 1,864,000 copies/ml. The patient expressed a great interest in resuming combination therapy. Treatment was started with pegylated interferon alpha 2-a, 180 mcg weekly, plus ribavirin, 1200 mg orally, daily for forty-eight additional weeks. After twelve weeks of treatment, HCV-RNA by PCR was again undetectable. The patient completed the entire course without further complications and laboratory exam at six-month follow up confirmed a sustained virologic response. No worsening of her visual acuity developed over the entire retreatment period and repeated dilated fundoscopic exam proved complete resolution of the initial findings. Conclusion: Although no formal guidelines exist on how to manage patients with hepatitis C who develop interferon-associated retinopathy, we found with close ophthalmologic monitoring it is often possible to safely continue therapy.