Health and vision screening is not routinely undertaken in Nepal. The control of severe ocular dysfunction such as vitamin A deficiency and cataract blindness is understandably of great concern to both local health authorities and non-government organisations. In January 1994, a screening program was conducted in two orphanages in the Kathmandu district. A total of 220 children were examined who ranged in age from 5-17 years. The failure rate on tests of vision and ocular motility was 23.6 % as defined by the examiners’ criteria for this project. A variety of reasons including the lack of public health programs, low socio-economic status, and the influences of adolescent myopia and inadequately trained convergence are discussed as possible contributors to this high referral rate.