Background: Childhood blindness is among the disabilities in children below 16 years worldwide especially in developing countries, the prevalence of childhood blindness in low income countries is 7.8 per 1000. The major causes of blindness in children vary from area to area. Blindness in children has direct effects for the affected child and family and all the way through life strongly influences educational, employment, personal and social prospects. Objective: To determine the causes and risk factors of childhood blindness at eye department at Kilimanjaro Christian Medical Centre. Methods: A hospital based cross sectional study, involved all children diagnosed having unilateral and bilateral blindness who attended eye department clinic in 2016. Data collection was done through designed forms on specific objectives, the study was based on the children under 16years of age available in the files, and then data was collected, entered and analyzed using SPSS statistical package. Results: 88 participants were enrolled. The majority of the participants were males (68.2%), largest age-group were those between eleven and sixteen years who accounted for (43.2%). The leading cause of blindness was trauma which accounted for (39.25%) of the cases. The majority of the cases (90.9%) had unilateral blindness. The most common cause of unilateral blindness was trauma which accounted for (36.25%) of the cases and the most common cause of bilateral blindness was congenital by (50%). The commonest risk factor contributing to childhood blindness was found to congenital anomalies (38.6%) and albinism being the least (8%). Conclusion: It evident that males and age between eleven and sixteen year’s group are more affected with childhood blindness. The leading cause of blindness in children is trauma (32.95%), the leading cause of unilateral and bilateral blindness are trauma (36.25%) and congenital (50%) respectively. The commonest risk factor contributing to childhood blindness was congenital anomalies by (38.6%). Childhood blindness has social economic impact as it affects the development of a child academically, economically and socially.