Visual impairment (low vision and blindness) is a major health concern all over the world. Three main reasons for the high prevalence of visual impairment are non-availability, non-accessibility andnon-affordability of eye care services. However, there are several factors that may act as barriers to the use of available, accessible and affordable eye care services. These include the lack of knowledge of the services, lack of knowledge of the possible impact of an eye disease and lack of knowledge of who to consult for management of eye diseases. Also, demographic, personal, social and cultural factors may influence or act as barriers to eye care utilization. These various factors are reviewed in this article. Where there is poor utilization of available services, educational campaigns would lead to better understanding and promote greater utilization of eye care services. Early detection and management of eye diseases would reduce the burden of visual impairment and disability. Therefore, eye care providers and health care managers must have good knowledge of the various factors that would negatively influence utilization of eye care services and be responsive to them. (S Afr Optom 2010 69(4) 182-193)