<p>Research literature about visually impaired students’ approach to mathematics is still very scarce, especially in the case of algebra, even though mathematical content is becoming increasingly accessible thanks to assistive technologies. This paper presents a case study aimed at describing a blind subject’s process of algebraic symbol manipulation while solving equations supported by assistive technology. In particular, we analyze how a subject with blindness manifests their structure sense within algebraic instrumented activity mediated by programming languages (such as LaTeX). The epistemic and pragmatic mediations of the programming language are described in terms of the developed utilization schemes. The results show how hearing can replace the eye in developing algebraic structure sense. Data analysis reveals that the system of screen reader, speech synthesis, and programming language has interesting potentialities in the development of structure sense for subjects with blindness, but, taking an inclusive perspective, we discuss how these potentialities can be applied more generally in mathematics education.</p>