We report two patients with marked visual loss due to injection within the optic nerve sheath. Findings included severe visual loss, optic disc edema, retinal edema, and intraretinal, preretinal, and vitreous hemorrhage. A review of similar cases in the literature reveals a common but ill-advised use of sharp retrobulbar needles with the technique of retrobulbar injection described by Atkinson. A modified technique which limits the risk of optic nerve trauma is described.