Introduction Data on ocular morbidity is essential for planning primary and referral eye care services. Objectives Determine the prevalence and causes of self-reported ocular morbidity and eye care service utilization in Sri Lanka among adults ≥ 40 years of age. Methods Multistage, stratified, cluster random sampling was used to select a nationally representative sample aged ≥40 years. All participants were administered a questionnaire to assess ocular morbidity they had experienced in the previous month and the pattern of service utilization for reported eye problems. The interviews were conducted by a team of trained investigators at the clinical examination site before they underwent an eye examination. Results 5779 of those presenting for a clinical examination were interviewed among 6713 enumerated (86.1%). The prevalence of self-reported ocular morbidity was 89.9% [95% Confidence Interval (CI): 89.0–90.6%]. Near vision impairment was the commonest problem reported (72.1%; 95% CI: 70.8–73.3%) followed by distance vision impairment (36.2%; 95% CI: 34.9-37.5%). Among those reporting an eye problem, 31.4% sought treatment. 49.4% of those seeking care utilized private facilities. Financial constraints, perceptions that the condition was not serious or had insufficient impact on day-to-day tasks were the most important reasons for not accessing care. Conclusions Ocular morbidities are common in the Sri Lanka population; however utilization of services is relatively low, particularly for asymptomatic illnesses. It is important that the service planners take into account geographical and social inequalities and focus the services on underserviced areas and disadvantaged social groups.