Up to 50% of childhood blindness is preventable or treatable, and its control is a high priority in the VISION 2020 initiative of the International Agency for the Prevention of Blindness. In this study, the authors utilised the rapid assessment of avoidable blindness (RAAB) sampling methodology. It is worthy to note that the blindness estimate of 10/100,000 is lower than reported by Muhit in Bangladesh (30/100,000). This is likely due partially to almost complete absence of corneal blindness in the actual study. That is in keeping with Nepal’s strong public health program distributing vitamin A and consistent with global trends. It is also likely due to high measles vaccine coverage in Nepal. The leading anatomical cause of childhood blindness and severe visual impairment (BL/SVI) in this study was refractive error (55%) in contrast with a middle-income setting such as Iran that identified retinal diseases (44%) as the primary cause of BL/SVI. In addition, the study supports use of female community health volunteers in the key individuals (KI) role as they were able to mobilise children using their close connections to individual communities and familiarity with government health and eye programs. Finally, the prevalence of visual impairment and blindness in children in the Narayi Zone of Nepal of 55/100,000 indicates the need for improved paediatric ophthalmic services, mainly refractive error correction in rural areas.