Return of vision following orbital decompression after 36 hours of postoperative blindness

A 43-year-old woman undergoing repair of an orbital floor fracture had no light perception postoperatively. Computed tomography showed a normal optic nerve and there was no optic canal fracture, intraorbital hematoma, or intraconal expansion. After a two-wall orbital decompression, visual acuity recovered to 20/70 although only an inferior nasal island of vision remained. Ductions were full and there was no blepharoptosis but a 2+ afferent pupillary defect persisted.