Purpose: To compare tear film osmolarity (TFO) and other dry eye tests between diabetic children and normal healthy children.Materials and Methods: Twenty-six diabetic children (Group 1) and 20 healthy children without any ocular and/or systemic disorder (Group 2) were enrolled in the study. Detailed ocular surface assessment including, ocular surface disease index (OSDI) questionnaire, TFO measurement (Tear Lab Osmolarity System, San Diago, CA, USA), corneal epithelial thickness (CET) measurement using the anterior segment optical coherence tomography (OCT) (RTVue CAM, Optovue Inc, CA, USA), tear film break-up time (TFBUT) test, Schirmer test, meibography, and conjunctival brush cytology were performed. The results were compared between the groups.Results: The mean TFO was significantly higher in Group 1 (328.8 12.8) than Group 2 (313.6 +/- 15.1) (p = 0.001). The mean Schirmer test score was significantly lower in Group 1 (16.7 +/- 5.1) than Group 2 (23.6 +/- 5.6) (p = 0.00). Cytologic analysis revealed grade 0 changes in 11 patients (42.3%), grade 1 changes in 13 patients (50%), and grade 2 changes in 2 patients (7.7%) in Group 1 whereas grade 0 changes in 18 patients (90%) and grade 1 changes in 2 patients (10%) were observed in Group 2 (p = 0.004). The TFO levels were significantly associated with HbA1c levels (r = 0.459, p = 0.018).Conclusion: The study revealed significantly higher TFO, lower Schirmer test scores and changes in conjunctival cytology in diabetic children. Altered ocular surface changes in diabetic children may be due to the result of increased TFO.