Ophthalmic complications in pediatric acute lymphoblastic leukemia (ALL) have become serious and recognition of ocular manifestations of leukemia is fundamental. In this study, we aimed to detect radiological findings among ALL patients. Patients and methods: This cross sectional study was conducted in Pediatric Oncology Unit and Ophthalmology Department; Faculty of Medicine; Zagazig University with a total of 45 patients diagnosed with ALL (18 patients were denovo ALL, 14 patients were receiving treatment of leukemia and 13 patients finished their treatment protocol and were on follow up schedule). Detailed radiological work up was done including MRI of brain and both orbits, fundus photography, fluorescein angiography (FA), optical coherence tomography (OCT) and orbital CT. Results: Ocular manifestations were detected in 35.6% of ALL patients by ophthalmic examinations. 44.4% of ALL patients had abnormal brain MRI and most commonly, ischemic changes, post-radiation leukomalacia and CNS infiltration were detected. Twenty-two percent of the studied cases reported abnormal orbital MRI and most common abnormalities were sutural metastasis and optic nerve affection. Fundus photographs were done for selected patients. Optic nerve head leukemic infiltration, choroidal, retinal and vitreal infiltration were detected (4.44%). Moreover, CMV retinitis was detected in one patient. Conclusions: Several ocular abnormalities are present in pediatric ALL and the most common are retinal lesions. Knowledge about ocular problems in children with ALL could be beneficial to reduce morbidity and mortality.