Background: Currently, there are at least 2.2 billion people worldwide with visual impairment, of whom at least 1 billion have preventable or untreated vision loss. The world faces major challenges in ophthalmology. This includes inequalities in the coverage and quality of prevention, treatment and rehabilitation services. shortage of qualified ophthalmologists; poor integration of eye care services into the health care system, among other problems; Therefore, we conduct this study. Aim: To identify the causes of visual impairment in Kerbala province, Iraq with view to address the treatment and challenges may face during the action. Methods: The study was a cross-sectional , 200 patients who attended the ophthalmology outpatient clinic in AL- Hussien Teaching hospital,  Kerbala province, Iraq were enrolled,  aged 20 and above.  Data was collected by interviewing the patients and filling out the questionnaire from July 2019 until June 2020. In addition, we observed visual acuity measurement (VA), intraocular pressure (IOP), and ophthalmological examination of the patients Results: The main leading cause was a refractive error with 99 individual (51.3%) followed by cataract 26 (13.5% ). Refractive errors and cataract together were 24 (12.4%), allergy 14 (7.3), infection 12 (6.2%), age-related macular degeneration 12 (6.23%) and lastly glaucoma was only 6 (3.1%). According to the age group, 34 (17.6%) were between (17-39), followed by 102 (52.8%) between (40-59) and 57 (29.5%) between (60-89). In all these three groups RE was also the main diagnosis, 24 (70.6%) ,  7 (55.9%)  and 18 (31.6%) respectively. According to the smoking habit, 159 (82.4%) were nonsmoker, 14 (7.3%) were ex-smokers, 5 (2.6%) were light smokers (reported consumption of ≤5 cigarettes per day), moderate smokers (1 day for smoking 8 (4.1%) reported consuming 11 to 19 cigarettes per day ) , heavy smokers (reported smoking more than 20 cigarettes per day) 7 (3.6%) ز As regards systemic disease, we found that 80 (41.5%) of patients have hypertension and 63 (32.6%) were diabetics. Conclusions: We found that refractive errors were the most common cause of reduced visual acuity followed by cataracts. Cataracts are the most frequent cause of visual impairment in older people.