The current study investigated the impact of birth weight on the ability to recognize facial expressions in adulthood among the longest known prospectively followed cohort of extremely low birth weight survivors (ELBW; <1,000 g). We measured perceptual threshold to detect subtle facial expressions and confusion among different emotion categories in order to disentangle visual perceptual ability from emotional processing. ELBW adults (N = 64, Mage = 31.9 years) were more likely than normal birth weight (NBW) controls (N = 82, Mage = 32.5 years) to see fear in angry faces. This finding was not a result of increased perceptual efficiency in processing fearful expressions in the ELBW adults, since the two groups did not differ on their threshold to detect emotion in low intensity facial expressions. These findings suggest that a processing bias toward fear may reflect long-term developmental effects from being born at ELBW that may portend socioemotional problems that characterize ELBW survivors.