Primary empty sella syndrome (PESS) on background idiopathic intracranial hypertension (IIH) presenting with profound bilateral visual loss is a rare clinical occurrence. We report the case of PESS on background IIH in a 37-year-old obese Nigerian female. At presentation, she had a history of an insidious onset of loss of vision in both eyes with an associated history of headaches and tinnitus. Clinical examination and imaging studies revealed papilloedema and empty sella with a completely flattened pituitary gland. This report highlights that PESS could initially present to an ophthalmologist as a case of profound bilateral visual loss.