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A 69 year old woman with a history of diabetes mellitus presented with acute abdominal pain, nausea, and vomiting. Clinical, laboratory, and radiological findings were consistent with a diagnosis of acute pancreatitis. Fundus examination showed a milky-white discoloration of some blood retinal vessels in both eyes (fig 1). This ophthalmoscopic appearance, termed lipaemia retinalis, is an unusual retinal manifestation of hypertriglyceridaemia and occurs only in pronounced raised concentrations of serum triglycerides.1 Our patient had a triglyceride concentration of 82.64 mmol/l (reference <2.03 mmol/l). She made an uneventful recovery, and one week after admission triglycerides decreased to 6.17 mmol/l while the creamy-white appearance of retinal vessels reverted to normal.