title: Visual defects in Nepalese children with Down syndrome.
abstract: BACKGROUND
  Down syndrome (DS) is a common chromosomal anomaly. People with this syndrome have recognisable physical characteristics and limited intellectual abilities. The aim of this study was to determine visual defects, especially refractive error and binocular anomalies, in a sample of Nepalese children with DS.
  
  
  METHODS
  Thirty-six children with DS (19 boys and 17 girls) from the Kathmandu valley, aged from four months to 18 years, underwent detailed optometric examination. Cycloplegic refraction was performed on all subjects. Vision on presentation of all the children was assessed with preferential looking cards, the Kay picture cards, the Bailey-Lovie logMAR chart or the Snellen chart. Binocular function was assessed with cover test, Hirschberg or Bruckner test.
  
  
  RESULTS
  Cycloplegic refraction of the children revealed that 80 per cent of the children had significant refractive error. Most of them had hyperopia (55 per cent), followed by astigmatism (44 per cent), myopia (25 per cent) and anisometropia (19 per cent). Only two (5.6 per cent) children were strabismic and both of them were alternating esotropes. Nystagmus was present in 10 (28 per cent). Other ocular findings were upward slanting palpebral fissures, blepharitis, congenital nasolacrimal duct obstruction, blepharoconjunctivitis, chalazion and lenticular opacities.
  
  
  CONCLUSIONS
  Nepalese children with DS have a high prevalence of refractive error and nystagmus. Regular eye examinations are indicated for these children to enable early diagnosis and appropriate management of ocular disorders to improve their vision and quality of life.
authors.affiliation: Department of Ophthalmology, BP Koirala Lions Center for Ophthalmic Studies, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal. paudel.nabin@gmail.com <paudel.nabin@gmail.com>
authors.forename: Nabin
authors.initials: N
authors.lastname: Paudel
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Leat
authors.forename: Prakash
authors.initials: P
authors.lastname: Adhikari
authors.forename: J Margaret
authors.initials: JM
authors.lastname: Woodhouse
authors.forename: Jyoti Baba
authors.initials: JB
authors.lastname: Shrestha
mesh_terms: D000293:Adolescent; D015858:Anisometropia / Q000453:epidemiology; D001251:Astigmatism / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004314:Down Syndrome / Q000453:epidemiology*; D005260:Female; D006801:Humans; D006956:Hyperopia / Q000453:epidemiology; D007223:Infant; D007767:Lacrimal Duct Obstruction / Q000453:epidemiology; D008297:Male; D009390:Nepal / Q000453:epidemiology; D009759:Nystagmus, Pathologic / Q000453:epidemiology*; D015995:Prevalence; D012030:Refractive Errors / Q000453:epidemiology*; D013285:Strabismus / Q000453:epidemiology; D015348:Vision, Binocular