Introduction: Globally 80% of the 596.3 million people worldwide who are blind or visually impaired have conditions where sight could be restored or where interventions could have prevented visual loss. An even greater number have less severe conditions where treatment is warranted. In low-and-middle income countries (LIMCs) the main reason why people become or remain blind is lack of access to eye care services. Primary health care (PHC) is the cornerstone of health care, and the same applies to eye health. However, primary eye care (PEC) as an integral component of PHC is lacking in most LMICs. In response, the World Health Organization AFRO region recently launched a PEC package for Africa (WHO AFRO PEC package) to be delivered at PHC level. It has facility-based management and health promotion components. A literature review identified many limitations to the delivery of PEC in Africa, and no studies explored the extent to which PHC has the capacities to deliver PEC. This mixed-methods study aimed to address this in six districts in Anambra State, Nigeria. Methods: The study had the following elements: literature reviews of 1. PEC in LMICs and of theoretical frameworks on the feasibility of delivering health interventions; 2. review of relevant Nigerian policy documents; 3. a Delphi exercise to finalise the technical complexity of the two components of the WHO AFRO PEC package and the capacities needed at PHC level to deliver it; 4. development and pilot testing study tools; 5. a study in 48 PHC facilities (33 health centres and 15 health posts) and 5. In-depth interviews with district level supervisors and purposively selected heads of nine facilities. Data were analysed to identify capacity gaps using WHO’s health systems framework. Results: The following key gaps were identified: underdeveloped policy in relation to PEC in Nigeria; weak supportive supervision and lack of referral systems; eye conditions are not being recorded in registers or reported; marked under-staffing of health centres but not health posts and high staff turnover; most facilities lacked visual acuity charts and almost all had no eye medication in stock. The majority of facilities focussed on maternal and child health which was reflected in the age of patients who attended. Only four facilities provided eye care services. Two unexpected findings were that a quarter of those working in study facilities were ad hoc workers or graduate volunteers, and some facilities were visited by eye care providers who provide services. Health promotion consisted mainly of creating awareness of services available at primary health care facilities and did not promote health. Furthermore, health promotion activities were largely unsupervised and focussed mainly on maternal and child health activities. Conclusions: Recommendations arising from the findings in relation to the delivery of the WHO AFRO PEC package as an integral component of PHC include the need to realign and strengthen policies; eye conditions need to be included in health management systems; training should be included in pre-service training of all PHC cadres and supervisors will need orientation on PEC; referral systems need to be put in place; all facilities need visual acuity charts and torches; advocacy will be needed to ensure all medication included in the Essential Drugs List are available, and strategies will need to be adopted to increase demand