Posterior subcapsular cataract is a well-known complication of corticosteroid treatment. While this association has not been established for adrenocorticotropic hormone (ACTH) treatment, similar side effects would be expected for the 2 drugs given the mechanism of ACTH, which stimulates glucocorticoid synthesis and secretion. The authors report 2 children who were treated with ACTH for infantile spasms who developed bilateral posterior subcapsular cataracts. The authors recommend that children treated with ACTH be referred promptly to a pediatric ophthalmologist as these young, often developmentally delayed children may not exhibit recognizable signs of visual loss. Prompt evaluation and treatment of cataracts in children is important to prevent permanent vision loss from deprivation amblyopia.