Optic nerve hemangioblastoma (ONH) is a rare tumor that is usually unilateral and most commonl occurs in the context of von Hippel-Lindau (VHL) disease. Differential diagnosis is based on clinical history and imaging. Magnetic resonance imaging with gadolinium enhancement is the most useful imaging modality as it can reveal flow voids and an absence of dural attachment, differentiating ONH from other more commonly encountered optic nerve tumors. ONH are usually well-circumscribed vascular lesions composed of stromal cells and vascular endothelial cells. These lesions are diagnosed at a mean age of 37 years and can be asymptomatic, but over time patients may develop reduction in vision, proptosis, and pain. Surgical excision is well described via orbital, transsphenoidal or transcranial approaches. Given the risks associated with surgery, a stepwise conservative approach is advocated by most clinicians in the absence of severe symptoms. Although uncommon, this optic nerve tumor should be considered in young patients presenting with pain, proptosis, and optic nerve pallor, with or without a history of VHL disease.