AIM: To ascertain the pattern of ocular morbidity in a population of primary school children in rural Kenya as it is a prerequisite for planning effective preventive and therapeutic strategies. METHODS: A cross-sectional survey of ocular symptoms and clinical eye examinations were performed in a sample of 35 rural primary schools in the semi-arid region of Kajiado West sub-county in S.W. Kenya, amongst a semi-nomadic tribe (Maasai). Students in Grades 1-8 were included. Visual acuity was measured using the Snellen “tumbling E” chart at 6 m. Children with symptoms of refractive error underwent non-cycloplegic refraction. RESULTS: A total of 2036 children (1084 males) between the ages of 4-20y were examined. Conjunctival actinic changes were present in 22% (442/2036). Nine cases were seen with a potential squamous carcinoma. No overt classical ocular signs of vitamin A deficiency were noted, although 181 (8.9%) children complained of nyctalopia. Three hundred thirty-six (16.5%) children had a visual acuity worse than 6/12 in either eye, were unable to read N10 near text at 40 cm or had symptoms suggestive of refractive error. Refractive data led to an estimate of hyperopia of +1.00 D or more in 3.9% and of myopia of -0.50 D or more in either eye in 3.0% of the study population. CONCLUSION: Solar exposure- and dust-related conjunctival pathology is common. As this may develop into potentially sight- or even life-threatening conditions, it warrants further study, and preventive strategies may be needed. Complaints of nyctalopia were common and could suggest vitamin A deficiency. The prevalence of refractive errors is low in this rural African population.