Ocular complications represent a frequently overlooked yet clinically significant problem in pediatric intensive care units (PICUs). Critically ill children are particularly vulnerable to ocular surface disorders due to factors such as mechanical ventilation, sedation, neuromuscular blockade, decreased level of consciousness, and prolonged length of stay. Disruption of physiological protective mechanisms—including tear production, blinking, and complete eyelid closure—predisposes this population to exposure keratopathy, corneal injury, and infectious complications, which may result in long-term visual impairment if not promptly identified and managed. This book chapter provides a comprehensive overview of ocular complications in pediatric intensive care units, focusing on their pathophysiology, prevalence, risk factors, and clinical consequences. Current evidence demonstrates that ocular surface disorders in PICUs are common but largely preventable through early recognition and systematic care. Particular emphasis is placed on lagophthalmos as a key pathophysiological mechanism and modifiable risk factor. The chapter further reviews preventive and protective strategies, highlighting the superiority of moisture chamber applications over isolated use of lubricants and other traditional methods. A central component of this chapter is the role of nursing care in the assessment, prevention, and management of ocular complications. Structured ocular assessment, nurse-led fluorescein screening, and risk-based monitoring are discussed as essential elements of safe care. In addition, the integration of NANDA-I nursing diagnoses, NIC interventions, and NOC outcomes is presented as a framework for delivering standardized, evidence-based, and measurable eye care in pediatric intensive care settings. Finally, the chapter emphasizes the importance of nurse education, standardized protocols, and quality improvement initiatives in reducing preventable ocular complications. Strengthening nursing leadership in ocular care is proposed as a key strategy for enhancing patient safety and preserving visual health in critically ill children.