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To report a case of occult globe perforation following craniofacial surgery.A 16-year-old girl presented with vision loss and hypotony of her left eye following a craniofacial procedure, including bilateral medial canthopexy. This report describes the evaluation and findings following the craniofacial surgery.After recognition of vision loss and concern for rupture, surgical exploration was performed by an ophthalmologist at an outside institution on suspicion of globe penetration/perforation. Surgical exploration did not identify any scleral entry/exit sites. She was then referred for vitreoretinal consultation. Serous choroidal detachments and associated retinal detachment were identified on ultrasound. The patient was maintained on her postoperative oral antibiotics and followed closely. As the intraocular pressure improved, the choroidals began to resolve. Two retinal break sites were identified on opposite sides of the globe in the retinal periphery. Laser retinopexy was performed at the two penetration sites. The patient recovered excellent vision without any additional complications.Early recognition and high suspicion of globe injury is critical in cases of postoperative vision loss following craniofacial surgery.