I'd like to throw out an unusual case I saw a while back to see if more minds can help shed light on it for me. Late 30's white male was admitted to the hospital for abdominal pain and, concerned that he may have gallstones he underwent an ERCP, which I believe lasted 2-3hrs. While undergoing this he was lying prone, slightly on his left side to help the GI doc. As soon as he woke up he complained of not being able to see anything at all out of his left eye. For whatever reason, I got the consult the following day, approximately 24 hours later. 20/30 OD, LP os. Big time APD. Moderate orbital signs of proptosis (2 mm by Hertels) mild limitation of adduction and 1+ conjunctival injection. Fundus examination completely normal, no retinal swelling, optic nerve looks very healthy. So I get a STAT CT, nothing, but a little proptosis. MRI, same thing. I call my friendly neuro-opth, who is concerned that he may have bleed into his optic nerve and offers optic nerve sheath decompression! Anyway, while I'm waiting I do a bolus Solumedrol, with little change in his vision. I also get a fluorescein which shows a very fast transit time. One day after his first presentation he shows a little retinal swelling, not present on initial exam. Bottom line, I sent him directly to neuro-ophth and he told me that he thought it was due to hypovolemia during the case. I spoke at length to all docs involved in his case and they swear no such thing took place during the procedure, which was very uneventful. The only thing that I found out later was about the positioning during the procedure. He may have been lying direcly on this eye during the 3 hr procedure. The neuro guy did not recommend any hypercoag work-up. This nice, father of a 2 year old is naturally upset, and I don't know quite what to say to him. I'm also a little afraid of being called as a witness if he decides to go litigious. As far as I can tell from my own research there are case reports of blindness following surgery, other than eye surgery, but it seems to be a rare complication. Has anyone else experienced this? Any thoughts on etiology?