Marfan syndrome, homocystinuria, trauma, and simple ectopia lentis are the most common causes of pediatric lens subluxation. Many patients are best treated with a careful refraction of the phakic or aphakic pupillary axis. For those patients not achieving satisfactory refractive results, endocapsular lensectomy using modern automated vitreous cutting devices is relatively safe and successful. Given the lack of postoperative capsular support and our current level of intraocular lens technology, postoperative optical correction is most safely achieved with aphakic contact lenses or spectacles.