Eye disease constitutes an incapacitating condition with significant socioeconomic consequences. Regional differences occur in the pattern of presentation, which influence preventive strategies in order to achieve the goals of Vision 2020 global initiative. The purpose of the study is to determine the prevalence and causes of eye disease in Wesley Guild Hospital, Ilesa in order to provide a database for the planning of primary eye care delivery system. Medical records of new consecutive patients presenting in the eye clinic of Wesley Guild Hospital, Ilesa over a 5-year period (January 2000 - December 2004) were studied. The prevalence of eye disease was 2.3%. A total of 1717 patients had eye disorders. The mean age was 52.0 years +/- 2.4 s.d, with a female preponderance (Male: Female ratio 1:1.2). The leading diagnoses were cataract (26.0%), refractive error (18.5%), allergic conjunctivitis (12.4%) and glaucoma (10.9%). High volume cataract surgery, health education, early diagnosis and prompt management while incorporating, primary eye care within the comprehensive health care system could reduce the impact of the preventable causes of blindness.