BACKGROUND: The objective of this study was to determine the causes and distribution of vision impairment and refractive error among children in Zimbabwe.METHODS: A hospital-based retrospective cross-sectional study was conducted among children (3-16) who attended the Eye Institute, Harare, Zimbabwe, from January 2010 to December 2020. Patients’ records were collated, and variables such as visual acuity, ocular morbidities, and vision impairment were analysed.RESULTS: During this time, 1038 children with  mean age of 10.63 ± 3.54 years visited the facility. The majority of them were males (53.2%). Prior to treatment, 9.9% of the children had vision impairment which reduced to 3.5% after  intervention. Uncorrected refractive error accounted for the majority of vision impairment (67.0%), followed by keratoconus (7.8%), corneal opacity/ulceration (6.8%), and amblyopia (6.8%), among other conditions. Astigmatism (60.6%) was the most prevalent type of refractive error followed by myopia (37.5%).CONCLUSION: The prevalence of childhood vision impairment is higher than that found in similar hospital-based studies conducted in Africa. The most common reason for childhood vision impairment was uncorrected refractive error.KEYWORDS: Vision impairment, childhood, Zimbabwe, refractive error, keratoconus