Purpose. The number of children exposed to cocaine in utero each year is increasing. Recent reports suggest significant visual anomalies in infants prenatally exposed to cocaine. The purpose of this retrospective study was to determine if children exposed prenatally to cocaine were at a greater risk for visual abnormalities, such as strabismus and significant refractive errors. Methods. This pilot study was conducted at two sites, an outpatient clinic and a hospital-based practice. Consecutive files from January to July, 1993, of 79 children (aged 4 months to 94 months), who were identified by case history or meconium analysis information as being exposed to cocaine in utero, were reviewed. Fifty-five children met the inclusion criteria for the study. In addition, a control group of 100 pediatric patients were randomly selected from the pediatric patients seen at the outpatient clinical site. Results. Of the 30 children from the Illinois Eye Institute (IEI) and the 25 children from The Children's Hospital (TCH), spherical refractive errors in the right eye ranged from +6.50 to —12.50 D. The median refractive errors were +0.75 and +0.50 D, respectively. No statistical difference was found in spherical refractive error, astigmatism, or anisometropia between the cocaine-exposed cohorts and the control group (N=100). Strabismus was found in 15/55 (27%) of the children in the cocaine-exposed group. There was a statistically significant difference in the prevalence of strabismus between the cocaine-exposed group and the control group. Further analysis revealed that full birthweight (>2500 g) children prenatally exposed to cocaine were at a greater risk for strabismus as compared to the full birthweight control group. Ocular abnormalities were rare, but included optic nerve atrophy and retinopathy of prematurity. Conclusions. These data suggest cocaine exposure during pregnancy may place a child at risk for conditions that may negatively impact the visual system, specifically strabismus.