Purpose <p>Cerebral visual impairment (CVI) is a brain-based condition which can be exacerbated by clutter. This study aimed to explore the relation between clutter and visual fatigue in children with CVI and evaluate the effectiveness of clutter algorithm metrics in assessing visual clutter in photographs of children's play areas and the relation to visual fatigue.</p> Methods <p>Visual clutter was measured using algorithmic metrics, subjective observations by a clinical researcher (who also observed visual fatigue) and a Qualtrics survey.</p> Results <p>Seventy-two children (mean performance age = 7 years 4 months) were included. Visual fatigue was present in over 90% of children. Results revealed a relation between clutter and visual fatigue observations (<i>r</i>_<i>s</i> = 0.29; <i>p</i> = 0.01) and between visual clutter observations from researchers and Qualtrics participants (<i>r</i>_<i>s</i> = 0.32; <i>p</i> = 0.02). Certain metrics were correlated with visual clutter observations (<i>r</i>_<i>s</i> ranging from −0.30 to 0.51, <i>p</i>-values ranging from &lt;0.001 to 0.03), but not with visual fatigue.</p> Conclusions <p>Children with CVI presented with visual fatigue, particularly in cluttered environments. Therefore, parents, caregivers, teachers and clinicians should be attentive to visual fatigue signs, as early recognition and intervention can help address the child's needs more effectively. Algorithms that effectively quantify visual clutter are valuable tools that can be integrated to enhance the assessment of clutter and its relation with visual fatigue to advance CVI research methodology. However, a clinician is required to assess visual fatigue and to obtain detailed information on environmental clutter, which algorithms alone may not fully capture. Finally, we recognise that visual fatigue and the impact of clutter should be integrated into psychoeducation and the comprehensive assessment of individuals with CVI.</p>