Numerous mechanisms of vision loss in silicone oil–filled eyes have been described in the literature. Silicone oil can cause keratopathy, glaucoma, optic neuropathy, and cataract.1,2 There have been reports of unexplained severe vision loss in eyes with good visual potential with long-term silicone oil tamponade.3 Imaging and histological studies of eyes that have had a silicone oil tamponade show that oil droplets infiltrate various ocular tissues, including the retina.4-6 Numerous reports have documented the migration of silicone oil into the brain.2 Some have suggested that infiltration of oil droplets into the neuroretina causes macular dysfunction. Herein, we describe a man with a long-term silicone oil tamponade in an eye with good visual potential who developed severe vision loss and an unusual central scotoma.