The aim of this study was to assess the primary eye care knowledge, skills, and productivity of primary health workers at dispensaries in a district in Tanzania. Factors likely to contribute to knowledge, skills, and productivity were also assessed. A descriptive cross-sectional study design was used. All health workers employed at government dispensaries in Mwanga District, Kilimanjaro Region, Tanzania were included. A skills score of respondents, comprising knowledge and ability to test visual acuity and diagnosis and management of common eye conditions, was measured through interview and direct observation. Factors associated with the skills score were assessed. Forty nine health workers were assessed. There was poor understanding of basic ocular conditions and how to assess visual acuity; the mean skills score of all respondents was 6.2 out of 12. There was little association between having received training and the skills score. The mean number of eye patients managed per health worker was three per month. Findings suggest that a reassessment of the roles and responsibilities in primary eye care of dispensary health workers, review of training curriculum and teaching, and supervisory procedures may be necessary.