We present the case of a patient with the unusual combination of a single branch retinal artery occlusion and recurrent spontaneous miscarriages. Laboratory testing revealed elevated levels of IgA and IgM suggesting that this patient has primary antiphospholipid syndrome. Primary antiphospholipid syndrome, which has not been previously described in the optometric literature, may be characterized by a combination of vascular thrombosis, recurrent fetal loss, thrombocytopenia, livedo reticularis, and is frequently associated with systemic lupus erythematosus. Treatment is controversial with both anticoagulants and steroids having been suggested. This syndrome may cause neurological findings ranging from amaurosis fugax to frank cerebrovascular accidents. The optometrist should therefore be aware of the existence of this type of autoimmune disorder, and realize that in those cases where no other etiology for the ocular findings are readily apparent the advisability of a rheumatological consult should be considered.