Central retinal artery occlusion is rarely associated with traumatic optic neuropathy, this case report details of one such case. The reported case is of a ten-year-old boy presenting after a fall from height with loss of vision in one eye. Vision was reduced to no perception of light and a CT scan revealed fractures of the medial orbital wall and roof and a diagnosis of traumatic optic neuropathy with central retinal artery occlusion was made. Surgical intervention was performed within 24 hours with optic canal decompression through a transorbital route. Postoperatively the child’s vision returned to 6/9 within one month, which was maintained at a five year follow-up. This highlights the possibility of a local decompression of the optic nerve using a transcaruncular-transorbital approach combined with direct fibrinolysis, which in this case provided an excellent visual outcome.