A 45-year-old Caucasian woman presented with chronic bilateral, painless, progressive, peripheral vision loss. She was found to have bilateral optic atrophy and non-enhancing multifocal white matter lesions on magnetic resonance imaging of the brain. Cerebrospinal fluid analysis showed elevated myelin basic protein. She was diagnosed as the carrier state of X-linked adrenoleukodystrophy (X-ALD). X-ALD can mimic the clinical and radiographic features of multiple sclerosis in a female carrier. This is the first case report of bilateral optic atrophy in a female X-ALD carrier in the English ophthalmic literature 1).