This retrospective study investigated the ocular manifestations of autistic spectrum disorders (ASD) among children in a paediatric ophthalmic practice setting. Fifty-three patients were identified. Assessments were undertaken for 44 with 68% having autistic disorder, 16% with pervasive personality disorder – not otherwise specified – and 16% with Asperger’s syndrome. Male:female ratio was 3:1. Ocular abnormalities were found in 52%. Strabismus was present in 41%, significant refractive error in 27%, anisometropia in 7% and amblyopia in 11%. The percentage of ocular abnormalities was higher than that in the general population.