Background: Visual and hearing impairments are common co-morbid conditions for Down syndrome (DS). Combined sensory loss can present major communication challenges, which affect the opportunities for equal participation, learning, and development. This article focuses on facilitating social interaction. Method: The study uses conversation analysis based on video recordings of naturally occurring interaction during various activities in school. The sample consists of five children with DS and combined sensory loss and their teachers. Results: The results indicate that the pupils use gaze and vision actively in interaction with adults and respond actively to the other's communicative use of gaze. Gaze is an important resource for the pupils and is strategically used to regulate, orient, and establish attention, but also to express interest and intention. Discussion/conclusion: Despite the pupils’ visual impairment, eye contact plays an important role in their communication. To optimize meaning-making and communicative participation, it is important to have knowledge of the individual child's specific sensory and communication challenges as they occur in social interaction. This will increase the opportunity to uncover pupils’ communicative strategies, resources, and tactile preferences, which in turn are prerequisites for the facilitation of participation, learning, and development.