OCT images from a 43-year-old man with a history of hypertension, type 2 diabetes, chronic kidney disease, and proliferative diabetic retinopathy who had previously undergone vitrectomy for bilateral traction retinal detachment. He presented to the emergency department with a hypertensive urgency requiring admission and initiation of dialysis for acute renal failure. A, Imaging performed 2 months after these events. Notably, hyperreflective lesions on the infrared (IR) image (to the right of the OCT image) were new and not present at prior ophthalmologic visits. OCT shows sub-RPE deposits and subretinal and intraretinal fluid, consistent with hypertensive choroidopathy, and Elschnig spots. The patient was observed without retinal intervention while blood pressure and renal issues resolved. B, Vision stabilized and fluid resolved without further ocular intervention, with some fading of the IR hyperreflective lesions and inner retinal thinning over the following 18 months.