A patient with polycythemia vera, who presented digital arterial occlusion and episodic monocular blindness as the first clinical signs of the disease is described. After an early diagnosis, reduction of the cellular blood volume, and intraarterial perfusions with adenosine triphosphate (Laevadosin) followed by reserpine (Serpasil) led to adequate local tissue perfusion. No surgical intervention was required and visual disturbances disappeared. The patient has now been in a stable phase of the disease for 7 months without subsequent treatment.