Out of 77 bone marrow transplanted patients surviving at least 1 year, 43% developed ocular manifestations of the sicca syndrome. This reaction was more frequent in patients with graft-versus-host disease (GVHD). Kerato-conjunctivitis sicca (KCS) developed in 28 patients (54%) who had survived acute GVHD but in only five cases (20%) of those without that complication. The incidence of dry eyes was 62% in the chronic GVHD group. All seven sicca cases in patients with aplastic anemia were seen in patients with chronic GVHD, while 10 out of 26 patients with hematological malignancies and without chronic GVHD had KCS. Two of these had not experienced any acute GVHD. Irradiation may contribute to the development of KCS, since all patients with hematological malignancies, in contrast to aplastic anemia patients, had undergone total body irradiation.