PurposeTo present two rare pediatric cases of bilateral acute occlusive retinal vasculitis (ORV) associated with respiratory viral infections.MethodsThis retrospective review of two cases included a comprehensive clinical evaluation and detailed examinations, including wide-field RetCam color fundus photography, fundus fluorescein angiography, B-ultrasound imaging, aqueous humor cytokine analysis, and laboratory testing for viral infections. Treatments consisted of antivirals, corticosteroids, and anti-VEGF therapy.ResultsBoth patients presented with severe vision loss, retinal hemorrhages, retinal vascular occlusion, and exudative detachment. Elevated intraocular VEGF and IL-6 suggested an immune-mediated response. Despite treatment, both had poor visual recovery with optic atrophy and retinal vessel attenuation.ConclusionRespiratory viral infections may trigger severe pediatric ORV via immune-mediated inflammation. In these two cases, early diagnosis, viral screening, and prompt treatment were applied, but the prognosis remains poor. Further research is needed to refine management strategies.