Symptomatic compression of the optic apparatus by a tortuous internal carotid artery (ICA) is rare. We report a patient with visual decline due to optic nerve compression by the ICA. The patient presented with a visual field deficit and standard work-up revealed no discernible cause. Magnetic resonance imaging (MRI) demonstrated distortion of the optic nerve by the ICA. The optic nerve was decompressed with resultant clinical improvement. Optic nerve compression by the ICA may be considered a diagnosis of exclusion. Here, microvascular decompression led to improvement in visual function. You can submit your Manuscripts at: https://symbiosisonlinepublishing.com/submitManuscript.php