We aimed to investigate the prevalence and causes of visual impairment (VI) in an elderly Tujia ethnic rural population in Southwest China.From June 1 to December 31, 2018, a random cluster sampling survey was conducted among Tujia individuals aged 50 years or older in the rural areas of Qianjiang District County in Chongqing. The sampling design used village-based clusters of approximately equal size (1000 people). The sampling frame was composed of 110 clusters including 26,527 adults aged 50 years or older; 10 clusters (2556 adults) were randomly selected, and 2122 subjects were examined. Ophthalmologic examinations and questionnaires were administered to all the participants. Low vision and blindness were defined using best-corrected visual acuity (BCVA) and presenting visual acuity, according to The World Health Organization standard. The prevalence of VI was estimated, and causes of VI were identified.The participation rate was 83.0%. The prevalence of VI was 15.2% (BCVA 8.0%). In the study population, the prevalence of low vision and blindness increased with age (P < .05) and was higher among those with a low education level (P < .01). The majority of VI was attributed to cataracts (50.0%) and uncorrected refractive error (35.7%). With BCVA, cataract (79.3%) was the most common cause of VI, followed by age-related macular degeneration (10.7%).The main causes of VI in Tujia ethnic were cataracts and refractive errors. Both cataracts and refractive errors are curable eye diseases; thus, local health institutions need to adopt a more active eye care project as a strategy to prevent blindness.