The authors report a retrospective review of two cases of optic nerve sheath decompression in children (age younger than 16 years) and review the literature on the procedure. Two children underwent optic nerve sheath decompression. Optic disc edema resolved in both eyes after surgery. Some degree of visual improvement was obtained in one eye of each patient after surgery, but one eye was unchanged in one patient and one eye of the other patient had worsening of visual acuity after surgery. Neither patient suffered any systemic complications from the procedure. Of 12 patients in the literature (including these 2 patients), 66% experienced improved visual acuity following optic nerve sheath decompression, 33% had improvement in visual field, and 17% suffered worsening of visual acuity and visual field after surgery. Although optic nerve sheath decompression is a relatively safe and effective treatment for visual loss due to papilledema in adults, significant complications, including further visual loss, may occur. The experience with this procedure in children is limited, but retrospective data suggest that the safety and efficacy of the procedure may be comparable with that in adult patients.