In 282 eyes from 141 newborns and 278 from mothers where no mothers had signs of ocular Zika, 29%–46% of newborns had 5 patterns of ophthalmic lesions. Ophthalmic abnormalities were directly related to the severity of microcephaly and were related to Zika symptoms in the first trimester of pregancy. All mothers and their newborns tested positive for IGG and IGM. It is unknown whether the ophthalmic abnormalities are related to the microcephaly, the virus itself, or combined mechanisms.