Patients with long bone fractures are at risk for the fat embolism syndrome (FES). Although an estimated 50% of patients with overt FES have retinal abnormalities, the overall incidence of fundus lesions in patients with long bone fractures has not been studied. We examined 100 consecutive patients who had suffered long bone or pelvic fractures in the absence of head, abdominal, or thoracic injury, and who had no other diseases associated with retinopathy. Only one patient had visual symptoms. Cotton-wool spots and retinal hemorrhages were observed in four patients, none of whom were suspected of FES prior to our examination. Subclinical FES may be found by ophthalmoscopy in patients with long bone fractures.