In seven patients, permanent bilateral visual loss was the chief neurological residual following relief of tentorial herniation. The causes of herniation were unilateral subdural hematoma in three patients and bilateral subdural hematomas, bilateral subdural empyemas, traumatic intracerebral hematoma, and postoperative infarction in one patient each. Three patients, including two with occipital infarction documented by computed tomographic scan, developed optic atrophy, indicating that both pregeniculture visual pathway damage and posterior cerebral artery compression occurred. Increasing availability of computed tomographic scanning should help eliminate this rare cause of blindness by facilitating earlier diagnosis of supratentorial masses.