This is a case report and review of the literature of this rare, but well recognised alarming complication. The authors discuss the possible mechanisms, suggesting that it does not arise from a direct injury to the optic nerve and is more commonly a result of an ischaemic injury to the blood supply of the optic nerve. They dismiss anaesthetic hypotension as a contributor. They note most of the previous recorded cases occurred in middle-aged patients and in the right eye. They suggest that in the high Le Fort I osteotomy, informed consent should include visual loss as a complication, implying that fracture propagation is involved. Since this is not substantiated by imaging it tends to confuse their ischaemia theory. Considering the frequency of the surgery of a Le Fort 1 osteotomy and the rarity of the complication, I doubt it would influence a patient’s decision to proceed but may ease the tense postoperative conversation should it occur.