Because the Zika virus (ZIKV) has spread rapidly in northeastern Brazil and other parts of the Americas, de Paula Freitas and coauthors evaluate the ocular findings in infants with microcephaly associated with presumed intrauterine ZIKV infection in Salvador, Bahia, Brazil. In this case series, 29 infants with microcephaly with a presumed diagnosis of congenital ZIKV were recruited. Twenty-three of 29 mothers (79.3%) reported suspected ZIKV infection signs and symptoms during pregnancy. Of the 29 infants (58 eyes) examined, ocular abnormalities were present in 17 eyes (29.3%) of 10 children (34.5%). Bilateral findings were found in 7 of 10 patients presenting with ocular lesions, the most common of which were focal pigment mottling of the retina and chorioretinal atrophy in 11 of the 17 eyes with abnormalities (64.7%), followed by optic nerve abnormalities in 8 eyes (47.1%), bilateral iris coloboma in 1 patient (2 eyes [11.8%]), and lens subluxation in 1 eye (5.9%). These data suggest that congenital infection due to presumed ZIKV exposure is associated with vision-threatening findings.