This study examines how accessibility for persons with visual impairments is understood and carried out in public libraries in Skåne, Sweden. Based on eight semi-structured interviews with library staff from seven public libraries, the study explores how accessibility is understood in everyday library practice. The material was analysed using Reflexive Thematic Analysis and interpreted through Aimi Hamraie’s concept of access-knowledge. The findings show that accessibility work is largely centred on adapted media, assistive technologies, and services such as Legimus. While these forms of support are well established, broader aspects of accessibility, such as participation, independent navigation, and inclusion in everyday library life, receive less attention. The findings also suggest that librarians’ understanding of visual impairment is shaped by the users they encounter most frequently, particularly older users and users seeking adapted media. As a result, accessibility work tends to develop around needs that are already visible within existing library services. The study concludes that accessibility is shaped not only by physical environments and available services, but also by how accessibility needs are recognised, understood, and prioritised within library organisations. By applying Hamraie’s concept of access-knowledge to public library settings, the study highlights the role of organisational knowledge in shaping accessibility practice.