Four months later the ESR was 2 mm/h. A high index of suspicion should be maintained in patients with elevated sedimentation rates and ischaemic optic neuropathies. If any clinical doubts exist, steroid treatment should be initiated and a temporal artery biopsy performed. In relation to Case 2, steroid treatment on the basis of a significantly raised ESR would have been inappropriate. The cotton wool spots detected on fundoscopy in Case 2 represented retinal nerve fibre layer infarcts.