Giant cell arteritis as the underlying cause of blindness in the elderly is common in the West but is not seen except on rare occasions in South East Asia. We describe an 86-year-old Chinese man from Singapore who presented with a central retinal artery occlusion. Biopsy of a prominent superficial temporal artery established the underlying cause to be giant cell arteritis which was also the eventual cause of death as the condition resulted in rupture of a dissecting aneurysm of the aorta. Giant cell arteritis should be considered in all cases of ischaemic eye disease in the elderly. The importance of early diagnosis lies in the very high incidence of second eye involvement within days or at most weeks in untreated patients. A high index of suspicion is required for diagnosis of this condition which is likely under-diagnosed in our local context.