Thirty-eight patients (39 eyes) with optic nerve sheath meningiomas were entered into a treatment plan and were followed up for at least three years. Eighteen eyes were simply observed because they had minimal functional deficit or the eye was blind. Radiation was used on six eyes with documented progressive visual loss that still had useful vision. Surgery was initially used in an attempt to remove optic nerve sheath meningiomas but was abandoned except in exceptional cases. Total surgical removal of the tumor was carried out in ten eyes with loss of vision and in which the meningioma was growing. Surgery for subtotal or complete removal of the tumor followed by radiation was carried out in five eyes exhibiting aggressive growth of the tumor. This treatment plan has helped us to treat patients with optic nerve sheath meningiomas in an orderly way.