Ischaemic optic neuropathy and resulting visual loss is a known perioperative complication. In the intensive care unit (ICU), however, it is rarely seen. We present a case of ischaemic optic neuropathy and describe factors associated with this condition, found in the current literature. Our patient who was admitted and treated in the ICU of Medical Center Haaglanden in The Hague, is a 33-year-old male, who sustained blunt abdominal trauma resulting in liver rupture. He underwent multiple operations, was mechanically ventilated in the prone position with high positive end-expiratory pressure (PEEP) received large amounts of fluids and was treated with vasoactive drugs. He developed blindness because of ischaemic optic neuropathy (ION). We believe that the ION was caused by a combination of risk factors. Current anaesthetic literature describing ION after surgery indicates several independently associated risk factors for this rare complication. In our patient these were male sex and the large volume of estimated blood loss. Further review of the literature suggests massive fluid resuscitation, hypotension and the use of vasopressors as possible risk factors, but these are not proven to be independently associated with ION. © 2015, Netherlands Society of Intensive Care. All rights reserved.