A 51-year-old diabetic and overweight male presented to our eye clinic with right-sided impairment of visual acuity and scotoma. A thorough work-up had been carried out at our institute 9 months prior to this event due to left-sided nonarteriitic anterior ischemic optic neuropathy (NAION). Despite the similarity of visual symptoms in the currently and previously affected eyes microcystic anemia (Hb 81 g/dl) associated with severe hemorrhoidal bleeding was diagnosed. The patient underwent surgical hemorrhoidectomy and received two red blood cell concentrates. Therefore, this article reports on an extraordinarily rare case of shock-induced anterior ischemic optic neuropathy (SIAION) caused by hemorrhoidal bleeding.