Visual loss in 4 patients with tuberous sclerosis complicated by subependymal giant-cell astrocytoma is reported from the Departments of Ophthalmology, Neurology, and Radiology, University of Michigan Medical Center, Ann Arbor, MI. The patients presented at 12-20 years of age with obstructive hydrocephalus. Surgery relieved elevated pressure in all cases but 2 patients became blind and 1 has severe visual field loss from the effects of chronic papilledema on the optic nerves. Early surgical decompression prevented visual loss in the fourth patient whose tumor was removed at 12 years of age and who required further resection of a giant-cell astrocytoma at 20 years. 
COMMENT. Periodic opthamologic examination and brain imaging are advisable in tuberous sclerosis patients with subependymal nodules. The timely relief of increased intracranial pressure may arrest or prevent loss of vision.