1. Ophthalmic signs are important for the diagnosis and management of elevated intracranial pressure. 2. Visual loss, visual field loss, dorsal midbrain syndrome, and acute papilledema may occur well in advance of ventricular dilation. 3. For younger patients with hydrocephalus, amblyopia should be checked for, and the absence of papilledema does not ensure normal intracranial pressure. 4. Treatment should be delivered to control intracranial pressure and preserve vision in a timely fashion.