A man in his 40s with blurry vision in both eyes presented with headaches, arthritis, anorexia, and weight loss. Visual acuity was counting fingers OD and hand motions OS. Examination revealed a flat nasal bridge, anterior chamber cells, and vitreous cells (in addition to the posterior segment findings described in the Figure legend). Workup revealed antineutrophil cytoplasmic antibody (proteinase 3 antineutrophil cytoplasmic antibody) positivity, consistent with granulomatosis with polyangiitis. Treatment with systemic steroids was initiated and transitioned to methotrexate, cyclosporine, and infliximab. The systemic symptoms and ophthalmic findings improved.