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Posterior fossa tumours comprise up to 70% of paediatric brain tumours. To date, no UK study has looked at visual outcomes in paediatric posterior fossa tumours (PPFT) following surgical treatment. Our primary aim was to report rates of visual impairment, strabismus and nystagmus two years after diagnosis of a PPFT. A retrospective case note review of patients (age 0–18 years) with PPFTs within the Paediatric Oncology Database at a UK tertiary referral centre presenting between the 1st of January 2014 to 31st of December 2022.PPFTs were diagnosed in 156 paediatric patients. Exclusion criteria was demise within the follow up period (37 patients) and incomplete data (43 patients). Complete data was available for 76 patients. Hydrocephalus (82%) and papilloedema (46%) was noted at presentation. At the two year ophthalmology follow-up (mean 29 months) 40 (53%) patients had abnormal ocular findings. However, mean visual acuity was good: Right eye logMAR 0.08, (SD 0.21) Left eye LogMAR 0.06, (SD 0.20). Two patients had unilateral moderate-severe vison loss (0.6 logMAR or worse) and 2 had bilateral. 3 patients (4%) had visual field loss, 19 (25%) patients had nystagmus and 28 (37%) had strabismus. Ten patients (13%) underwent strabismus surgery.Papilloedema in PPFTs is the main threat to vision and management of intracranial pressure is vision preserving. Patients with PPFTs have good long-term visual acuity. The involvement of the brainstem in PPFTs results in strabismus and nystagmus as the main sequelae. Further prospective multicentre studies will be needed to inform future practice.