Pigmented paravenous retinochoroidal atrophy is an uncommon fundus disorder with a striking clinical presentation. It is characterized by the bilateral symmetrical appearance of posterior pole abnormalities including granular pigment cuffs around the larger retinal veins and their bifurcations and variable degrees of retinochoroidal atrophy about the affected veins and the optic disc. The maculas are spared of clinically observable abnormalities, and the vast majority of patients with this disorder are asymptomatic. Most of the approximately four dozen cases previously reported in the scientific literature have been discovered during routine ophthalmoscopy. The visual prognosis for patients with pigmented paravenous retinochoroidal atrophy is quite good. Two cases of this disorder are presented in order to draw attention to the clinical characteristics and the management of patients with a diagnosis of pigmented paravenous retinochoroidal atrophy.