Background: Intraocular surgery in patients with intellectual disability can be hazardous. Our aim was to determine the outcomes of surgery on all such patients seen in a consultant-led service, and to assess the overall risks and benefits. Materials and Methods: A retrospective chart review of patients with moderate to severe intellectual disability, operated upon over a 9-year period was undertaken. Thirty-four eyes of 21 patients were operated upon and procedures included four penetrating keratoplasties, five combined penetrating keratoplasties with cataract extractions, and 25 cataract extractions alone. Results: Most patients achieved a beneficial outcome, noted by their carers, such as better mobility and social interaction. Three patients had major post-operative complications, all associated with corneal grafts. Only seven patients were, within the context of conventional busy outpatient clinics, deemed capable of co-operating with a formal visual acuity assessment either pre- or post-operatively. Conclusions: Cataract and corneal graft surgery in individuals with intellectual disability is beneficial, and referral to an ophthalmologist should be considered as intellectual disability need not necessarily be a contraindication for surgery. The authors recommend that these patients should be assessed in a dedicated ophthalmology clinic setting for the intellectually disabled, where there should be better facilities for appropriate visual assessment tailored to the patients' abilities.