Giant cell arteritis (GCA) can present with cotton-wool spots in the retina and usually affects medium and large vessels. The authors present herein a 75-year-old man with GCA manifesting with cotton-wool spots and widespread retinal vasculitis affecting small-size retinal arterioles. The retinal vasculitis and the cotton-wool spots resolved after initiation of systemic corticosteroids and his vision returned to normal. GCA can uncommonly present with retinal vasculitis affecting small-size arterioles. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:1054-1056.].