BACKGROUND Down syndrome, first described in 1866, is the most common chromosomal derangement in live births. More than half of the patients with Down syndrome have ophthalmic manifestations. We wanted to evaluate the most common ocular abnormalities in children with Down syndrome in South India. METHODS All children with positive chromosomal analysis report for Down syndrome between 2 - 18 years attending a semi-urban, tertiary medical care centre from 1/1/2013 to 1/1/2015 were included in this hospital based clinical cross sectional study. Detailed ocular examination included visual acuity assessment using age specific tests, diffuse light examination, assessment of ocular alignment, motility, cover tests, slit-lamp biomicroscopy, cycloplegic refraction and direct and indirect ophthalmoscopy. RESULTS In our study, 95 % of children had ocular abnormalities. The most important defects were refractive errors (83.33 %), hyperopia (35 %), myopia 21 % of whom 2 children had high myopia of more than - 6D, and astigmatism (15 %). Among the refractive errors, hyperopia was the commonest. Other ocular abnormalities were cataract (13.33 %), esotropia (13.33 %), exotropia (3.33 %), nystagmus (6.67 %), nasolacrimal duct obstruction (8.3 %) and optic disc coloboma (1.6 %). CONCLUSIONS Refractive errors, strabismus were the most common and significant visual defects identified in children with Down syndrome in our study. Early detection of refractive errors, strabismus and prompt and appropriate intervention like glasses for refractive errors and surgical correction of strabismus is absolutely necessary to prevent development of amblyopia. Improvement of vision accelerates the overall development of the child. Management of Down syndrome children should be a team approach with ophthalmologist playing an important role. These children should have early and regular ophthalmological evaluations to maximise the benefit. KEYWORDS Down Syndrome, Ocular Abnormalities, Visual Acuity in Children
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