Optic neuritis (ON) is a common cause of visual loss in young patients. Patients with eye pain and ipsilateral visual loss are often referred into neuro-ophthalmology clinics with a possible diagnosis of ON. In 2018 Jefferis et al. reported a case series of six patients affected by unilateral vision loss, retro-ocular pain and ipsilateral photophobia in whom no structural abnormalities were found. The authors of this paper present a further four patients with retro-ocular pain with visual acuity loss and ipsilateral photophobia and no other evidence of ON. The authors of this paper agree with Jefferis et al. that a distinct clinical syndrome exists and propose the term Retro-Ocular Pain, Photophobia and Visual Acuity Loss (ROPPVAL) syndrome. All four of the reported patients had a previous (mis)diagnosis of ON. All had normal ocular and neurological examinations and no relative afferent pupillary defect. The paper discusses possible mechanisms and the role of cycloplegics in reducing symptoms, as well as the importance of distinguishing this syndrome from optic neuritis. The authors propose that ROPPVAL syndrome should be listed in the differential diagnosis of ON.