Two early fourteenth-century French Gothic ivory boxes depict the Old French La Folie Tristan, or Tristan the Fool: Musée du Moyen Age, Thermes du Cluny, Paris (Inv. No. 23840) and the Hermitage State Museum, St Petersburg (Inv. No. F-61). This article analyses the two boxes' unique visual interpretations of La Folie Tristan through word-image comparison, using texts in surviving manuscripts as guides. It also considers the ivory carvers' manipulation of pre-existing schema, and their rich and varied visual storytelling devices. Lastly, it explores the relationship between La Folie Tristan imagery and the accompanying episodes, for both boxes include other motifs. The article argues that the example in Paris offers a truncated interpretation of the story around the theme of deception in love, which fits well with surrounding images. The St Petersburg casket offers a more complete account of the tale with more narrative scenes and a wider range of themes.