All children with a new diagnosis of CdLS should be referred for ophthalmic assessment. In addition to problems which may be easily recognizable such as misaligned eyes (strabismus) or shaky eyes (nystagmus), ophthalmic examination is necessary to reveal possible nearsightedness (myopia) which might be quite severe yet otherwise go undetected. If the initial examination is normal, routine ophthalmic follow-up is usually not necessary unless new problems arise. However, it may be prudent to recheck for nearsightedness every few years until puberty.

Individuals who develop recurrent red eyes, crusting on the eyelashes, itchy eyes, tearing, or eye discharge should also see an ophthalmologist. Although the symptoms may mimic a blocked tear duct (nasolacrimal duct obstruction), they are more often due to blepharitis: an idiopathic condition in which the 20 - 30 glands normally present in each eyelid have sub-optimal flow. Rather than surgical treatment for a tear duct problem, baby shampoo eyelash scrubs can often result in dramatic improvement of the blepharitis symptoms. Older children with self-injurious behaviour can seriously damage their eyeballs. Any signs of self-induced eye injury should also prompt an ophthalmic referral.