Papilledema in idiopathic intracranial hypertension can result in blindness, with visual function loss being its only complication. The typical management begins with medications, and a shunting procedure may be needed. If the patient develops visual field or acuity loss, this will mandate an optic nerve sheath fenestration (ONSF) to salvage the nerve and thereby the visual function. It is important for every ophthalmologist, therefore, to know about ONSF, which, though indicated for a neuro-ophthalmic condition, needs to be performed only by an ophthalmologist. In this video, we shall vividly describe various methods of diagnosing papilledema and the meticulous planning of ONSF and provide an algorithm for choosing the appropriate case. The ONSF surgery will be demonstrated in detail, with appropriate landmarks for accessing the optic nerve, necessary instrumentation and important tips. This video will highlight different cases to show the benefits and simplicity of this technique, enabling surgeons to effectively perform ONSF when vision is threatened in cases of papilledema.