Bilateral lateral geniculate nucleus (LGN) injury is a rare cause of vision loss. We describe a patient with pre-eclampsia who developed profound but reversible bilateral vision loss, bilateral serous retinal detachments, and magnetic resonance imaging signs of a variant of posterior reversible encephalopathy syndrome (PRES) that affected both LGNs and spared the retrogeniculate pathways. We provide evidence that the visual loss was not from the chorioretinal lesions but from the LGN lesions. The concurrence of PRES and lesions attributed to choroidal hypoperfusion provides support for the notion that vasoconstriction also underlies the pathogenesis of PRES.