Background <p>The HELLP syndrome is a serious complication in pregnancy, characterized by haemolysis, elevated liver enzymes and low platelet count. We report a patient who was unaware of pregnancy presenting initially with bilateral visual loss and exudative retinal detachment and was diagnosed with HELLP syndrome during work-up.</p> Case presentation <p>A female patient, unaware of her pregnancy, presented with painless, severe bilateral vision loss and exudative retinal detachment. Multimodal imaging of her fundus revealed hypertensive choroidopathy and retinopathy. During systemic work-up, she was found to be 26 weeks pregnant and was diagnosed with HELLP syndrome based on laboratory abnormalities. Her vision fully recovered within 4 months following urgent pregnancy termination and blood pressure control.</p> Conclusions <p>This case highlights the importance of obtaining a thorough medical history and considering pregnancy-related complications in the differential diagnosis for reproductive-age women with acute vision loss. Prompt diagnosis and treatment of this condition are essential for the recovery of patients’ visual outcome.</p>