Purpose. To investigate tear function, ocular manifestations, and squamous metaplasia of the conjunctival epithelium (SMCE) in
children with end stage renal failure (ESRF) on dialysis. Methods. Thirty children with ESRF and 20 age and sex matched controls
during the period fromJanuary 2014 toMay 2015 underwent full ophthalmologic examination and the tear functionwas investigated
by the Schirmer and tear film break-up time (TBUT) tests. SMCEwas evaluated by impression cytology and immunocytochemistry.
The correlations of tear function status with ESRF-related clinical and biochemical variables were measured statistically. Results.
Dry eye symptoms were detected in 26% of children with ESRF, compared with none of the controls (𝑃 = 0.05) and SMCE was
almost absent. Values of the Schirmer and TBUT tests were significantly lower in children with ESRF for right eye (𝑡 = 24.63,
𝑃 = 0.01, and 𝑡 = 11.9, 𝑃 = 0.002, resp.) and left eye (𝑡 = 24.7, 𝑃 = 0.02, and 𝑡 = 11.4, 𝑃 = 0.0004, resp.). TBUT and the Schirmer
test values were correlated inversely with the duration of ESRF (𝑅 = −0.45, 𝑃 = 0.01, and 𝑅 = −0.46, 𝑃 = 0.01, resp.) and with the
duration of dialysis (𝑅 = −0.39, 𝑃 = 0.03, and 𝑅 = −0.45, 𝑃 = 0.01, resp.). None of the following parameters was associated with
distorted tear function including serum creatinine, electrolytes, parathyroid hormone, total protein, albumin, CBC parameters,
and systolic or diastolic blood pressure. Conclusion. The basal tear secretion and tear film stability were lower while the dry eye
symptoms such as itching and redness were more common among children with ESRF.The duration of ESRF and dialysis duration
seem to be related to the disturbances in tear secretion and tear film stability. However, SMCE is very rare.