A 58-year-old hypertensive man with a perfused central retinal vein occlusion of 21 days' duration received 50 microg of intravitreal recombinant tissue plasminogen activator in 0.1 cc. Best-corrected visual acuity improved 2 weeks after the injection. Optical coherence tomography and fluorescein angiography demonstrated resolution of cystoid macular edema and improvement of venous outflow. Intravitreal tissue plasminogen activator may be a useful treatment for central retinal vein occlusion with a duration of 21 days or less.