Protracted Postsurgical Blindness With Visual Recovery Following Optic Nerve Sheath Fenestration

Optic nerve sheath fenestration is an accepted surgical treatment for pseudotumor cerebri when visual loss occurs despite medical therapy. When performed via a medial approach, optic nerve sheath fenestration may require considerable traction on the optic nerve. The nature, severity, and potential reversibility of neural injury caused by sustained rotational traction on an already-compromised optic nerve is unknown. We describe a patient who suffered complete loss of vision in the surgically treated eye following optic nerve sheath fenestration and who subsequently recovered 20/30 OD visual acuity. REPORT OF A CASE. A 22-year-old woman noted headaches, pulsatile tinnitus, and bilaterally blurred vision beginning 2 weeks after the onset of a middle ear infection. She denied pain with eye movements or other neurological symptoms. Physical examination showed an obese woman with a blood pressure of 138/88. Corrected visual acuity was 20/80 OD and 20/70 OS. Both pupils reacted sluggishly to