Aim: Visual impairment and blindness are serious public health issues, especially in developing countories, like India. Data on causes of childhood visual impairment and blindness in Bihar are limited. The aim of this study was to determine the leading causes of visual impairment and blindness in blind schools of Bihar Study design: A cross sectional study was done in seven blind schools of Bihar Methods: Seven blind schools were visited after taking permission from principal. Written informed consent from parents was taken. Detailed ocular and systemic examination was done for all 218 students. Comprehensive eye examinations were performed, including distance visual acuity, anterior and posterior segment examinations, refraction, color vision, and visual field testing. Anatomical and etiological categorization of causes of visual impairment/Blindness was done. Results: A total 218 students were examined. 90.82% of students were blind and 9.17% severely visually impaired. Major anatomical causes of visual impairment and blindness were Microphthalmos (24.31%), Anophthalmos (23.39%), Optic Atrophy (9.63%) and Corneal Scar (7.80%). Etiologically the most common cause was of unknown etiology followed by postnatal factors. Preventable or treatable causes, such as glaucoma, cataract, and refractive errors, represented 22.48% of the cases Conclusion: Blindness and Low vision due to congenital ocular conditions affecting whole globe was the most common cause, further population based studies are needed to know the exact magnitude of problem and to make strategies to decrease the incidence. There is a need to strengthen current primary preventions strategies while tertiary referral centers, Low Vision setups, awareness program regarding Low Vision, special education, rehabilitation, ocular disability benefits and many more things need to be set up in the different health zones of the state to manage childhood preventable and avoidable blindness.