Purpose <p>This study aimed to evaluate the impact of refractive errors on functional vision and eye-related quality of life (QoL) in a cohort of African children, using the Pediatric Eye Questionnaire (PedEyeQ).</p> Methods <p>A comparative cross-sectional study was conducted involving 169 children aged 5–17 years (97 with refractive errors and 72 visually normal controls) and their parents/guardians. Refractive errors were classified based on cycloplegic refraction. The PedEyeQ was administered through interviewer-assisted sessions to assess functional vision and psychosocial well-being across child, proxy and parent-reported domains. Statistical analyses were conducted using Mann–Whitney <i>U</i>-tests for group comparisons and Kruskal–Wallis tests for subgroup analyses, with Bonferroni corrections applied for multiple comparisons.</p> Results <p>Children with refractive errors had significantly lower PedEyeQ scores across all domains compared with controls (<i>p</i> &lt; 0.01). Among refractive error types, astigmatism showed the most pronounced deficits in functional vision and psychosocial well-being. For children aged 5–11 years, median functional vision scores were 50 (43.7–70.0) for refractive error versus 90 (67.5–95.0) for the controls. Similarly, for children aged 12–17 years, the respective scores were 65 (45.0–75.0) and 90 (75.0–95.0). Proxy and parent-reported domains demonstrated similar findings, highlighting substantial impacts on family QoL and parental concerns.</p> Conclusion <p>Refractive errors, particularly astigmatism, impair functional vision and eye-related QoL severely in African children and their families, suggesting a need for early detection and correction to improve outcomes for these children.</p>