Abstract Background: Patients undergoing hemodialysis (HD) are subjected to the effects of both uremia and the dialysis proce-dure on multiple organ systems. Aim of Study: To evaluate ocular changes and complica-tions associated with chronic kidney diseases stage 5 on regular hemodialysis (CKD5d). Patients and Methods: This cross-sectional study included 63 Egyptian children with CKD5d, who were recruited from Pediatric Dialysis and Nephrology Unit, and 50 age and gender matched controls, from outpatient's clinic, Children's Hospital, Ain Shams University Cairo, Egypt. Detailed history, physical examinations, and some laboratory investigations were done for all. Ocular examinations were done by meas-uring the best corrected visual acuity (BCVA), anterior seg-ment, intra-ocular pressure (IOP), pre & pots-HD session, and fundus examinations. Results: Ocular examination revealed abnormalities in 20.6% of CKD5d patients, and 10% of controls; where the best corrected visual acuity (BCVA) was impaired in 19% of patients and 10% of controls, the difference was not statistically significant as regards the BCVA (p=0.086), while eye move-ment disorders, anterior segment abnormalities and fundus changes were found in 6.3%, 6.3%, 4.7% of patients respec-tively, no similar findings were reported in controls. Intraocular pressures (IOP) were normal in all patients and controls; however, the mean pre-HD IOP was significantly higher compared with both post-HD measures and the control group (p<0.001, <0.001 receptively). Patients with ocular changes were significantly younger, with longer duration of hemodi-alysis, lower hematocrit, and serum iron levels, compared with those without significant ocular changes (p=0.03, 0.007, 0.021, 0.041, respectively). Conclusion: The CKD patients undergoing HD may be at increased risk of developing visual complications, thus frequent ophthalmological examination & IOP monitoring are important.