Purpose: Refractive error is a leading cause of visual impairment globally. Spectacle is the most cost-effective intervention used for correcting refractive error. Different factors affect spectacle wear compliance. This study assessed the spectacle wear compliance and determinant factors among school children with refractive error in Addis Ababa, Ethiopia. Methods: This study was a cross sectional study with 318 study participants in primary school children of Addis Ababa. Multistage sampling was used. The students were examined by a team of optometrists. A structured questionnaire used to collect demographic and clinical data, spectacle use, and reasons for not wearing spectacle. Ethical clearance obtained from IRB. Results: The compliance of spectacle wear among primary school children in Addis Ababa was 35.2% (95% CI 30.0, 40.5). Factors associated with poor-compliance were being male (p < 0.001), having low power refractive error (< 5D) (p < 0.001), having negative attitude towards spectacle (p = 0.007) and prolonged spectacle use (>12 months) (p = 0.037). Non-compliance was not associated with age, type of refractive error and parental use of spectacle. The main reason for not-wearing spectacle were parental disapproval (20.2%) (95%CI 15.8, 24.6). Conclusion: Spectacle wear compliance is very poor among children with refractive error. Health care intervention and school health programs need to address factors affecting compliance.