A 74-year-old male was admitted to the hospital complaining of progressive visual decline. Medical history revealed diabetes mellitus, atrial fibrillation, hypercholesterolemia and gout. He worked as a crane operator in the harbor of Rotterdam, the Netherlands. At presentation, he reported a weight loss of 10 kg in the last three months. Visual acuity was 0.16 in both eyes. Initial laboratory investigation revealed a significantly raised erythrocyte sedimentation rate (128 mm/h) but otherwise no abnormalities. Computed tomography and magnetic resonance imaging of the brain showed no significant abnormalities. The ophthalmologist performed fundoscopy and fluorescein angiography (figures 1A and 1B).