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Objectives This study aims to determine the factors influencing eye care service utilisation and compliance with spectacles wear among school students.Design Mixed-methods study.Setting 27 community schools from 6 districts of Bagmati province of Nepal.Participants Adolescents with mild vision impairment who were screened at schools by their trained peers for visual acuity measurement and subsequently received subsidised spectacles for refractive error correction. For the quantitative study, 317 students from 21 schools completed the survey. For qualitative study, 62 students from 6 schools participated in 6 focus group discussions.Primary outcome measures Utilisation of eye care services and compliance with spectacles wear.Results Among 317 students, 53.31% were aged 15–19, and 35.96% were male. More than half (52.68%, n=167) did not use eye health services. Among students who did not go, 51.50% reported eye health facilities being far away. Thematic analysis showed that distance, COVID-19 and awareness were influential in the utilisation of eye care. The multivariate analysis showed urban residents were likelier (adjusted OR (AOR) 4.347, 95% CI 2.399 to 7.877, p