Objectives: The present study was undertaken to determine the risk of strabismus and ambylopia in children who underwent operation for hydrocephalus and to compare our results with those in previous studies. Methods: Full orthoptic and ophthalmological examinations, including cycloplegic refraction, were performed in all subjects. Results: Ten of 25 patients (40%) were found to have manifest squint. Four of these had esotropia and six had exotropia. No paretic squint or alphabetic pattern strabismus was determined. Refraction measurements revealed amblyogenic refractive errors (significant refractive errors that cause amblyopia) in five of the 25 (20%) patients in this study. Strabismus and the risk of amblyopia were found to be significantly higher in patients who experienced shunt revision than those who had not (P < 0.05). Conclusion: Amblyopia, strabismus, and other acquired defects in the visual system related to hydrocephalus should be closely monitored and treated when indicated. Regular ophthalmic supervision will provide and help to maintain the best possible standard of vision in children with hydrocephalus.