Introduction: Trisomy 21 is a genetic disorder caused by abnormal cell division results in an extra full or partial copy of chromosome 21.It is commonly known as Down syndrome. It is typically associated with delay in physical growth, characteristic facial features and mild to moderate intellectual disability. The parents are genetically normal and the extra chromosome occurs by chance. Ocular abnormalities like cataract, strabismus, and refractive errors are common. The aim of the present study was to report clinically significant ophthalmic manifestation in children with Down's syndrome. Material and methods: A prospective study was carried out in one hundred and twenty children with Down syndrome between the age group of one year to 16 years since January 2018 to September 2019. All children underwent ocular examination which included vision assessment, cyclo refraction, slit lamp examination and fundus evaluation. Results: One hundred and twenty patients with Down syndrome (One year six months to 16 years) underwent ocular examinations. Average age of presentation was +/-8 years. Most of the down patient was male 63.3%. Clinically significant refractive errors were present in 72%, cataract in 80%, retinal abnormality in 53.3%, epicanthal folds in 92%, lacrimal system obstruction in 68.3%, iris abnormalities in 26.6%. Strabismus was present in 74 patients (61.6%). Conclusion: This study concludes that the early detection of ocular abnormalities in children with Down syndrome has greater importance in reducing visual morbidity and better life expectancy.