To determine the distribution of refractive errors and clinical characteristics of strabismus in patients with Down syndrome. Patients with Down syndrome attending the Izmir Association for Supporting Patients With Down Syndrome in Izmir, Turkey, were screened for strabismus and refractive errors. All patients underwent a complete eye examination including cycloplegic refraction and dilated fundus examination. Ocular alignment was evaluated using the cover test and either the Krimsky or the Hirschberg corneal reflex test depending on the cooperation of the patient. Strabismic and nonstrabismic patients were compared for refractive errors, anisometropia, and amblyopia. Fifty-seven patients with an average (+/- standard deviation) age of 9.30 years (+/- 6.14 years; range, 1 to 31 years) were screened. Twenty-five (44%) were female and 32 (56%) were male. Eleven patients (19%) had strabismus. Ten (18%) had esotropia and 1 (2%) had exotropia. Infantile esotropia was observed in 3 patients who had no significant refractive errors. Seven patients had acquired esotropia; they had clinically significant refractive errors and anisometropia. A higher frequency of hypermetropia was noted in patients with strabismus (P < .05). Esotropia and hypermetropia are common in patients with Down syndrome. Early diagnosis and treatment of strabismus and associated ocular conditions such as refractive errors and amblyopia may improve the quality of life for these patients.