One hundred forty Chinese children with Down syndrome (DS) treated in the Child Assessment Centre of the Duchess of Kent Children's Hospital in Hong Kong between 1985 and 1996 underwent a detailed ophthalmologic evaluation, including test of visual acuity by behavioral testing or retinoscopy, determination of ocular motility, visual field examination, binocular examination for strabismus, determination of near point convergence and pupillary reflex, and/or slit lamp bimicroscopy and ophthalmoscopy to assess ocular health. Only 43 children (31%) had no ocular abnormalities. The overall incidence of ocular abnormalities was 69%, and included refractive error (58%), strabismus (20%), nystagmus (11%), blepharitis/conjunctivitis (7%), lens opacities (4%), and glaucoma (0.7%). No child had Brushfield spots or keratoconus. The incidence of refractive errors increased with increasing age and nearly doubled at school age. As compared with white children with DS, the Chinese children with DS exhibited a higher incidence of refractive error and a similar incidence of lens opacities but a lower incidence of strabismus, nystagmus, blepharitis, Brushfield spots, and keratoconus. Regular visual surveillance, especially of visual acuity, in children with DS as they mature is important in preventing amblyopia.