Background: Cataract is the leading cause of avoidable blindness worldwide, particularly in low- and middle-income countries like India. Despite the availability of effective surgical treatment under national programs, uptake of cataract surgery remains suboptimal due to various barriers, especially in rural and socioeconomically disadvantaged populations. Objectives: To assess the barriers to cataract surgery uptake among patients with operable cataract attending a tertiary care centre in South Rajasthan and to identify factors associated with non-uptake. Methods: A hospital-based cross-sectional study was conducted in the Department of Ophthalmology at a tertiary care centre in South Rajasthan from July to December 2025. A total of 235 patients aged ≥40 years with operable cataract were included using consecutive sampling. Data were collected using a pre-designed, semi-structured questionnaire covering socio-demographic details, clinical profile, awareness, and perceived barriers. Statistical analysis was performed using SPSS version 25. Descriptive statistics were used to summarize data, and Chi-square test was applied to assess associations. Logistic regression analysis was conducted to identify independent predictors of non-uptake. A p-value <0.05 was considered statistically significant. Results: The majority of participants were aged 60–69 years, with a predominance of rural residents and individuals from lower socioeconomic strata. Although 78.7% were aware that cataract is treatable, only 61.7% perceived the need for surgery. Overall, 61.7% of participants were willing to undergo cataract surgery. The most common barriers identified were cost concerns (46.8%), fear of surgery (41.3%), and distance to healthcare facility (38.7%). Significant associations were found between willingness for surgery and residence, education, and socioeconomic status (p < 0.05). Logistic regression analysis revealed that illiteracy, rural residence, cost concerns, and fear of surgery were significant predictors of non-uptake. Conclusion: Barriers to cataract surgery uptake are multifactorial, with economic, personal, and accessibility factors playing a major role. Targeted interventions focusing on awareness, financial support, accessibility, and patient counseling are essential to improve surgical uptake and reduce avoidable blindness.