Correct! The diffusion-weighted MRI is showing increased signal in both optic nerves, an indication of recent infarction. The cause was probably intra-operative systemic hypotension, which sometimes occurs accidentally or deliberately (to reduce hemorrhage that interferes with the surgeon’s view in the operative field). Called “peri-operative ischemic optic neuropathy” or “hypotensive ischemic optic neuropathy,” its mechanism is believed to be lack of perfusion of the intra-orbital optic nerve. The patient usually notices the vision loss upon regaining full consciousness, although it may initially be attributed to sedating analgesics. The radiologist’s attention should be drawn to the optic nerves and diffusion-weighted imaging should be included in the MRI study. Maintaining normal post-operative blood pressure is a reasonable gesture. Hyperbaric oxygen treatment and corticosteroids, often proposed, are not effective. Vision may spontaneously improve somewhat if the infarction has not been severe. Bilateral optic neuritis is not a favored diagnostic choice in this setting. Pituitary apoplexy can certainly occur in systemic hypotension, but you might expect to see a bitemporal hemianopia on visual field examination and anyway, the imaging abnormality here lies in the optic nerves, not the optic chiasm. And yes, visual cortex infarction can certainly occur in this setting, but the afferent pupil defect points to an optic nerve localization.