A 41-year-old female nurse's aide presented with a recent history of viral hepatitis B. Approximately 1 month after her liver functions had normalized she developed symptoms of optic neuritis with painful loss of vision and optic disc edema. Her laboratory studies revealed evidence of systemic vasculitis and glomerulonephritis. A discussion is presented of the patient's clinical course and a brief history of the systemic effects of acute hepatitis B infection (HBV); the pathophysiology for HBV-induced autoimmune optic neuritis (ON), management guidelines, and differential diagnoses are discussed.