Setting: All health disctrict in KwaZulu-Natal.Methods: An explorative-descriptive cross-sectional design, gathering both quantitative and qualitative data, was used. Data were collected utilising questionnaires, observation, and interviews. Results were analysed against the health systems framework.Results: A total of 28 optometrists responded to the survey, representing 60% of public health facilities that provide eye health care in KZN. The majority (53.6%) of optometrists were from district hospitals in rural areas. Facilities were generally inadequately equipped, with inefficiencies in service delivery including long waiting times and multi-tasking of clinicians. The absence of a financing model impacted the service at all levels. Conclusion:Policy development for eye health is necessary for KZN to deliver comprehensive eye health services. In particular, emphasis should be placed on the integration of eye health into primary health care and appropriate planning to foster accessibility and sustainability of services.