Background: The bluetongue virus serotype 3 (BTV-3) outbreak in the Netherlands in 2023 caused severe clinical signs in ruminants. The clinical and pathological signs in ruminants and their spread during the outbreak in 2023 are described. Methods: Data from the Dutch monitoring and surveillance system were available to describe clinical signs and pathological findings related to BTV-3 in sheep, cattle and goats. During the outbreak, 13 farms (five sheep, five cattle and three dairy goats) were closely monitored. Results: In 2023, BTV-3 infections were confirmed by real-time polymerase chain reaction in sheep flocks (n = 1807), cattle herds (n = 1864), goat herds (n = 62), alpaca and/or llama herds (n = 15) and one dog. Sheep exhibited the most severe clinical signs and had the highest mortality. In other animal species, a large variation in both occurrence and severity of clinical signs was observed. Limitation: Only 13 farms were closely monitored. Conclusions: The clinical signs observed in affected animals during the 2023 BTV-3 outbreak seem to be more severe than those observed during the BTV-8 outbreak between 2006 and 2008. It seems likely that BTV-3 will overwinter, similar to BTV-8. Therefore, the availability of an effective and safe vaccine is crucial to limit the future impact of BTV-3.