Blindness is one of the major complications that can occur during and after intranasal ethmoidectomy. Two mechanisms for blindness are apparent: (1) direct injury to the optic nerve and (2) retrobulbar (orbital) hematoma, which increases orbital pressure and compromises vascular supply and drainage to and from the eye. While several publications have discussed the management of blindness from a delayed operative vantage point, no publication has discussed the immediate management of blindness from intraoperative or immediate postoperative occurrence, stressing specific medical and surgical treatment. A review of the literature and the author's personal experience will be used as a basis to discuss the prevention and management of blindness during endoscopic intranasal ethmoidectomy. Case studies will be used to illustrate methods for prevention and management of blindness. If treated aggressively, blindness associated with retrobulbar hematoma can be reversed medically.