Background: Hemodialysis (HD) is an important and by far the commonest treatment for end stage renal failure (ESRF). Changes in intraocular pressure (IOP) are one of the eye problems among hemodialysis patients. Objective: To evaluate changes in intraocular pressure (IOP) before, during and after single dialysis session. To detect changes in retinal fiber thickness measured by Optical Coherence Tomography (OCT) 6 months after basic examination. Patients and methods: This prospective study was carried out on 80 eyes of 80 patients undergoing regular hemodialysis (HD), both males and females. The study was conducted in Aswan University Hospital. Results: There was statically significant (but clinically not significant) decrease in IOP during HD, but there was no significant decrease when measured six month later. No significant difference in the mean IOP as regarding group's age, sex and duration of dialysis was found. Significant decrease in mean average RNFL thickness during the six months was noted as well as between age groups. There was no significance decrease in retinal nerve fiber layer (RNFL) thickness regarding sex and duration. Conclusion: As there was loss of RNFL thickness in hemodialysis patients, visual field changes is recommended to be investigated on such patients. Also the effect of hemodialysis on patients with high IOP or glaucoma should be investigated as well.