Itō worked as background and creature designer on the survival horror video game Silent Hill in 1999. He was art director for its sequel, Silent Hill 2 (2001), working on both the original game and its reissue Restless Dreams, as well as being the chief monster designer/modeler. Itō was art director again in Silent Hill 3 (2003), as well as "drama camera designer".
The team disbanded with the release of the fourth game, Silent Hill 4: The Room in 2004 and for which Itō received a "Special Thanks" credit in the game. Itō and fellow Team Silent scriptwriter Hiroyuki Owaku went on to work together on Silent Hill: Cage of Cradle (2006), a digital manga published by Konami, downloadable for cell-phones and only available in Japan.
In 2012, Masahiro Ito stated on his Twitter that he would be willing to work on another Silent Hill game with Hideo Kojima. In 2014 he worked with Hifumi Kono and Takashi Shimizu on the video game Night Cry featuring Chris Darril (Remothered) and Kiyoishi Arai (Final Fantasy) for visuals, design and in image board team.
|Video game||Release date||Role|
|Silent Hill||1999||Monster designer, background designer|
|Silent Hill 2||2001||Art director, monster designer|
|Silent Hill 3||2003||Art director, monster designer, CGI movie editors, modeling, drama camera|
|Silent Hill 4: The Room||2004||Special Thanks|
|Silent Hill: Cage of Cradle||2006||Illustrator|
|Silent Hill: Origins||2007||Special Thanks|
|NightCry||2016||Art director, monster designer|