Background: External ocular infections are a significant cause of preventable visual impairment worldwide. The rise of extended-spectrum β-lactamase (ESBL) producing bacteria poses a serious threat to effective treatment. Objective: The aim of this study wastoinvestigatethe bacterial profile, antimicrobial susceptibility profiles and extended-spectrum β-lactamase production among bacterial isolates from patients with external ocular infections at Bahir Dar, Northwest Ethiopia. Methods: A hospital-based cross-sectional study was conducted among 377 clinically suspected patients from February9 to May 8, 2026. Data were collected using a structured questionnaire through face-to-face interviews.External ocular samples weretaken by an experienced ophthalmologist and optometrist, and processed using standard microbiological techniques. Antimicrobial susceptibility testing (AST) and phenotypic confirmation of ESBL productionwere performedaccording to CLSI guideline.Bivariate and multivariate logistic regression was used to investigate the association between predictors and outcome variables. P-values <0.05 with a 95% confidence interval were considered statistically significant. Results:Of the 377 cases, 219 (58.1%) were tested positive for atleast one bacteria. Most of the isolates were Gram-positive bacteria (n=141) with the most common being CoNS(n=78) and S. aureus (n=63). The most common Gram-negative isolates (n=78) were E. coli (n=24) and K. pneumoniae (n=23). Among the staphylococcal isolates, penicillin resistance was very high (≥98.4%) and 33.3% of S. aureus isolates were methicillin-resistant. One hundred twoGram-positive andthirty-seven Gram-negative isolates demonstrated multi-drug resistance. ESBL producers were detected in 20.8% (5/24) of E. coli and30.4%(7/23)K. pneumoniae isolates. Age ≥ 50 (AOR: 3.56), Ocular trauma (AOR: 7.52), ocular allergy (AOR: 7.01), previous ocular infection (AOR: 3.76), and previous ocular surgery (AOR: 3.98) were associated with external ocular infections. Conclusion: The high prevalence of bacterial external ocular infections with a significant burden of MDR and ESBL producing strains limits the use of conventional empiric therapy