Objective: To determine whether early surgical excision of complicated periorbital hemangiomas (CPHs) reversed refractive errors and prevented further visual complications; CPHs can cause visual complications including astigmatism, strabismus, and occlusion of the visual axis with resultant amblyopia. Design: Retrospective review of patient series from a tertiary care pediatric referral center. Nine patients with CPHs were managed by otolaryngology and ophthalmology services with complete surgical excision. Preoperative eye examination findings were compared with postoperative findings. Results: Comparison of preoperative and postoperative refraction measurements and/or eye examination findings indicated reduction of astigmatism and substantial improvement in vision as measured by refractive changes and reduction of pupillary occlusion. Conclusions: Total excision of CPHs is a safe and effective approach. When completed early, excision provides definitive therapy, reduces or eliminates astigmatism, and can prevent amblyopia in pediatric patients when pupillary occlusion is present.