The judge dismissed a lawsuit Friday brought by Natale, 79, saying the statute of limitations had run out on his medical-malpractice claims.
His lawyer, J. Conor Corcoran, said Monday that Natale was mulling an appeal.
Corcoran maintained that the court's decision ignored other legal arguments that the government was guilty of institutional neglect.
"We called it a tomato, they called it a to-mah-to, because," the lawyer said, "if they call it a to-mah-to, they can call the whole thing off."
Natale led the Philadelphia mob from 1995 to 1999 - a reign that abruptly ended when he was busted on drug charges and became the first Mafia don to turn on his own family.
His testimony for the government in four trials between 2000 and 2004 led to several convictions, including that of his onetime ally and successor as head of the local crime family, Joseph "Skinny Joey" Merlino.
Throughout Natale's time on the stand, his eyesight was failing, and, he claims, his federal handlers remained indifferent to his complaints.
When his daughter-in-law, a nurse, arranged for a specialist from the Wills Eye Institute to examine him as he was testifying at the federal courthouse in Philadelphia, a federal prosecutor blocked the visit, his lawsuit claimed.
Officials at the Allenwood, Pa., federal prison he called home for years also failed to provide a proper diagnosis, Natale argued, or allow him to see outside specialists who might have caught his vision problems in time to reverse them.
Government lawyers denied the allegations in court filings, saying prison eye doctors and even an expert from the Mayo Clinic examined Natale during his time behind bars.
Still, Corcoran alleged Monday that their inaction let precious time go by.
The judge, who did not once refer to Natale's criminal stature in her opinion, said the case boiled down to a judgment call on the medical advice of prison doctors. And since the statute of limitations on medical-malpractice claims in Pennsylvania is seven years, she said, Natale's time had run out.
So, until he decides whether to keep fighting the case, Natale will continue to live as he has since his release from custody in 2011, Corcoran said Monday - functionally blind, living in anonymity, and trying to enjoy his final years with his family.
"His eyesight continues to deteriorate," the lawyer said. "But he's making up for lost time and trying to be the kind of grandfather he's always wanted to be."