Background: The increasing prevalence of diabetes is leading to a rise in eye diseases, augmenting the risk of sight-threatening complications. This study aimed to evaluate the prevalence, awareness, and practices regarding eye diseases among patients with diabetes in KSA. Methods: This was a cross-sectional study among diabetics at two primary healthcare centers in Saudi Arabia, who were selected by convenience sampling. 323 patients with diabetes completed a self-administered questionnaire assessing prevalence, awareness, and practices regarding eye diseases, besides health status and quality of care measures. Descriptive analyses followed by exploratory subgroup analyses and linear regressions were performed to investigate factors associated with awareness and practices. Results: While diabetic retinopathy was reported by 40.9% of patients with type 1 diabetes and 9.8% of patients with type 2 diabetes, 35.8% and 12.6% of all participants reported cataract and glaucoma, respectively. Awareness that diabetes could damage the eyes was reported by almost all participants; the majority were also aware of the importance of glycemic control and regular eye examination in preventing eye diseases. In contrast, only 70.5% of participants underwent an eye examination by an ophthalmologist during the past year. Eye examination was associated with better patient awareness. Barriers mentioned by patients revealed a lack of knowledge about screening guidelines, in particular regarding the preventive nature of eye examinations. Conclusions: Despite high levels of awareness regarding diabetic eye diseases, a significant proportion of patients with diabetes did not report annual eye examinations. Both healthcare strategic efforts targeting the promotion of regular eye examinations and initiatives aiming at improving knowledge of screening guidelines should be encouraged.