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PURPOSE: The purpose was to compare vision and ocular disease among orphans to age-matched school children and determine the barriers they faced for ophthalmic care in Riyadh, Saudi Arabia. METHODS: Children of four orphanages of Riyadh (Gr1) were screened for vision refractive error (RE) and eye ailment on “World Sight Day–2019.” They were compared to age-matched school children (comparison group; Gr2). The rates of RE, strabismus, amblyopia, and allergic conjunctivitis were estimated in two groups. The coverage of existing eye services for orphan children was reviewed. RESULTS: We screened 53 children of Gr1 and 106 school children of Gr2. The risk of RE was statistically significantly higher in school children compared to orphan children (odds ratio [OR] = 2.4 [95% confidence interval (CI) 1.2; 4.8] P = 0.01). The coverage of refractive services for Gr1 was significantly lower than for Gr2 (OR = 0.09 [95% CI 0.02; 0.4] P = 0.001). In Gr1, blurry vision (12 children), red eye (2), and itchy eyes (1) were the main symptoms. In Gr2, no child had eye complaints. In Gr1, amblyopia (1), strabismus (1), history of ocular trauma and surgery (1), eye medications needed (2), and systemic health problems were noted in 9 children. In Gr2, amblyopia (4), strabismus (4), and history of ocular surgery were noted in 2 children. CONCLUSION: Orphan children had less rate of myopia compared to school children. However, unattended ocular pathologies were detected during the screening campaign. The coverage of refractive services was low in these underprivileged children compared to school children.