Objectives <p>To determine the frequency and types of ophthalmologic anomalies in children with cognitive impairment, identify the causes of visual impairment in these children, and assess the relationship between the severity of cognitive impairment and ophthalmologic anomalies.</p> Methods <p>A cross-sectional study was carried out between October 2023 and June 2024 on 80 children 7 to 17 years old with cognitive impairment and institutionalized in two centers in Kinshasa. Participants underwent a complete ophthalmologic examination and cognitive assessment using the Montreal Cognitive Assessment (MoCA) test.</p> Results <p>The median (interquartile range) age of the children was 14 (11–16) years. 55% were boys. Cognitive impairment was mild in 41.2%, moderate in 33.8%, and severe in 25% of the children. Overall, 74 (92.5%) children had at least one ophthalmologic abnormality, and 43.8% had multiple ophthalmologic abnormalities. Refractive errors (82.5%), stereoscopic disorders (22.5%) and strabismus (12.6%) were the most frequent disorders. Twenty-seven (33.7%) children had vision impairment. The causes of vision impairment were refractive errors (46.7%), strabismus amblyopia (20%), and cataract (13.3%). There was a significant association between the severity of cognitive impairment and both visual impairment and defective stereopsis (<i>p</i> = 0.035).</p> Conclusions <p>Ophthalmologic manifestations are frequent in children with cognitive deficits. They are dominated by ametropia. A substantial proportion of these children are visually impaired. Periodic ophthalmologic screening of these children via conventional pediatric health system or school health services is recommended.</p>