I read with interest the article by Kumari et al.[1] The authors describe successful management of a major intraoperative complication. Indeed, prolonged head-down position intraoperatively can predispose to an increase in intracranial pressure (ICP). However, when using optic nerve sheath diameter (ONSD) to detect raised ICP, the authors missed subtle tricks of the trade. ONSD is usually measured 3 mm behind the origin of the optic nerve as that is considered the most distensible part of the optic nerve sheath.[2] The figure accompanying the said article does not make any mention of the distance behind the origin of the optic nerve where the ONSD measurement was taken, but it is more than 3 mm as can be gauged by the distance between the calipers used in the measurement of ONSD. Obtaining a satisfactory image for ONSD measurement is imperative for proper utilization of ONSD as a tool to detect raised ICP. There have been suggestions regarding the sonographic quality criteria for optimizing ONSD measurements.[3] Also, the authors did not utilize ONSD measurement after mannitol administration. A reduction in ONSD after mannitol administration would have strengthened their claim that it was raised ICP only which caused delayed awakening and not residual sedation and paralysis.