A woman in her 50's was diagnosed diffuse large B-cell lymphoma (DLBCL) after presenting to hospital in a critical condition, characterised by marked hyperleukocytosis (white cell count 290 x109/L). She subsequently developed painless blurred vision bilaterally, and was diagnosed with bilateral central retinal vein occlusion secondary to leukostasis. She was managed with non-Hodgkin lymphoma R-CHOEP14 (rituximab, cyclophosphamide, doxorubicin, vincristine, etoposide, prednisolone) immunochemotherapy, with her ocular signs and symptoms improving following treatment. Optical coherence tomography and funduscopic examination demonstrated no evidence of intraocular lymphoma. Visual acuity returned to 6/6 in each eye with subsequent resolution of her symptoms. Repeat examination demonstrated stable appearance of her ocular disease.