While private hospitals provide an important access point for low vision services for children in urban India, little is known about this service delivery route. A cross sectional survey was done of consecutive records of 220 children presenting at a newly opened paediatric low vision centre in a private eye hospital in Hyderabad. On presentation, 49% of the children were classified as moderately visually impaired, 31% were severely visually impaired and 20% were blind. The four major causes of visual impairment were the hereditary/genetic conditions of congenital glaucoma, hereditary macular degeneration, retinitis pigmentosa and albinism. Approach magnification was sufficient for required near tasks in all pre-school children and about 50% of school children. Provision of a distance refraction decreased the prevalence of severe visual impairment and blindness by 31%. The most commonly prescribed low vision devices were spectacles indicating a key role for optometry in the management of visual impairment in Indian children. Establishment of low vision clinics in existing Indian eye hospitals using associated optometric staff would be a cost effective method to minimise visual impairment in Indian children.