There has been considerable current interest in the rotational behavior of red blood cells (RBCs) in optical tweezers. However, the mechanism of rotation in polarized tweezers is still not well understood and conflicts exist in the understanding of this phenomenon. Therefore, we reexamined the underlying phenomenon by use of confocal fluorescence microscopy in combination with optical tweezers. Under different osmolarities of the buffer, the three-dimensionally reconstructed images showed that the trapped RBC maintains its shape and is oriented in the vertical direction. Using dual optical tweezers, the RBC could also be oriented three-dimensionally in a controlled manner. The mechanism of orientation and alignment of RBCs with the polarization of the tweezers' beam was attributed to its form-birefringence rather than optical birefringence.