Background: Teaching reading skills is the cornerstone of all learning; therefore, teachers' adherence to this mandate is important. However, it becomes complicated and challenging if the teacher has to teach pre-reading skills to Grade R learners with visual impairments. In light of this challenge, researchers have endeavoured to determine the Technological Pedagogical and Content Knowledge (TPACK) that teachers should possess for the effective teaching of reading in classrooms with visually impaired learners. Aim: This article explores a small sample of in-service teachers' knowledge of using Braille to teach pre-reading skills to Grade R learners with visual impairments. Setting: The study was conducted in a School for the Blind in Maseru, Lesotho, where three Grade R in-service teachers teaching learners with visual impairments were purposively sampled. Methods: This study is underpinned by Koehler and Mishra's theory of TPACK. An interpretivist, qualitative small-scale case study approach was employed, using semistructured interviews and classroom observations. Document analysis was also used to corroborate findings. Results: Findings reveal that although some of the participants possess a high level of technological knowledge, they tend to teach Braille as a 'stand-alone' skill and fail to integrate it with the teaching of other pre-reading skills to Grade R learners. Conclusion: In-service teachers showed limited knowledge of some of the essential skills for teaching pre-reading skills to Grade R learners who are visually impaired. The study calls for supportive in-service teacher education programmes that equip Grade R teachers of learners with visual impairments with the necessary skills to teach pre-reading skills.