This paper details the technique for ocular assessment of the severely retarded child including the use of electrophysiological methods of examination and monitored dissociated anaesthesia. This examination is conducted in the child's hospital residential school environment. Analysis of these assessments shows a high incidence of pathological defects, strabismus, nystagmus, cataract and refractive errors. These findings are similar to the experience of an overseas clinic. A plea is made for early ocular examination in the first year of life in the suspected neonate to help establish a general diagnosis, prepare a plan of management and prevent secondary retardation.