Aim: To analyze various ocular diseases leading to permanent visual handicap in a district situated in central India based on visual handicap certification issued by the district ophthalmic surgeon after verification of the domicile of the person. Materials and Methods: Records of patients obtaining visual handicap certificate for complete blindness (visual acuity < 3/60 or central visual field less than 10 degree in the better eye) during 1 st January 2008 to 31 st December 2008 were identified. Information was retrieved and analyzed. Result: Two hundred and seventy nine people were blind (visual acuity <3/60 in the better eye) out of two thousand one hundred and ninety patients came for visual handicap certification. The causes of blindness were avoidable in 49.5% (diabetic retinopathy 12.9%, glaucoma 12.6%, corneal scar 14.0%, Steven Johnson syndrome 9.0%, retinopathy of prematurity 1.1%) and not preventable in 50.5% (retinitis pigmentosa 15.1%, congenital ocular malformations 13.6%, optic atrophy 12.5%, hereditary diseases 8.3%, and age-related macular degeneration 1.1%) patients. Conclusion: High prevalence of retinitis pigmentosa in the population warrants genetic counseling to be taken urgently. Early diagnosis and management is required to prevent blindness arising out of diabetic retinopathy and glaucoma. Newer challenges like congenital ocular malformations and retinopathy of pre-maturity were also seen. Screening for the retinopathy of prematurity should be made mandatory, as it is an increasing problem in countries with improving neonatal care services. Presence of bilateral corneal scar and Steven Johnson syndrome can be avoided by proper health education and inadvertent use of systemic medications.