Introduction Childhood blindness is largely attributable to preventable causes. In children with developmental delay, identifying ocular morbidity is particularly challenging due to limited cooperation and associated comorbidities. This study aimed to determine the prevalence and spectrum of refractive errors, strabismus, and other ocular findings among children with developmental delay attending a tertiary care center in South India, and to highlight the importance of early ophthalmic screening in this population. Methods This retrospective review included 100 preschool children with developmental delay (aged four months to five years) presenting to the ophthalmology outpatient department of a tertiary care center in South India over a period of two years. Visual impairment was defined as visual acuity below the age-appropriate expected level despite best correction, or, in uncooperative children, based on abnormal fixation behavior and inability to maintain central, steady fixation. Evaluation included visual acuity testing, refraction, ocular alignment assessment, and comprehensive ophthalmic examination. Results Visual impairment was observed in 66 (66%) children (95% CI: 56-75). Refractive errors were identified in 84% (95% CI: 75-90) of the cohort, with hypermetropia being the most frequent subtype (65, 78%), followed by myopia (15, 18%) and astigmatism (38, 45%). Strabismus was detected in 12% of children, most frequently exotropia. Causes of developmental delay included prematurity (69%), syndromic associations such as Down syndrome (10%), and miscellaneous factors (21%). Conclusion Nearly two-thirds of children with developmental delay had visual impairment, predominantly due to refractive errors and strabismus. Early ophthalmic screening and timely management are essential to reduce preventable visual disability and improve neurodevelopmental outcomes in this vulnerable group.

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