To date, little information has been available about the actual amount of tear secretion in dry eyes. In the present study tear secretion was studied in 20 consecutive dry eye patients [40 eyes; Schirmer test after topical anesthesia < 5.5 mm/5 min; at least moderate squamous metaplasia of the conjunctival epithelium; bengal rose staining (Bijsterveld score > 4); severe dry eye complaints]. Tear secretion was evaluated by automated, computerized objective fluorophotometry and compared with that in an age-matched healthy control group. Tear secretion of the dry eyes examined was found to have decreased drastically (0.2 +/- 0.2 microliters/min) compared with that in healthy control eyes (1.2 +/- 0.5 microliters/min; P < 0.001). None of the dry eyes had a tear secretion of > 0.4 microliters/min.