A 41-year-old man with pulseless disease presented with a sudden onset of visual loss in the right eye. The right fundus showed moderate optic disk swelling with mild pallor. Aortography demonstrated bilateral obstruction of the common carotid arteries and left subclavian artery, and only collateral vessels supplied the upper portion. Temporal artery biopsy revealed no inflammation. In addition, the patient originally had relatively small disks. This anatomical factor and marked hypoperfusion of the posterior ciliary artery presumably caused nonarteritic anterior ischemic neuropathy in this patient.