Clinically, dry eye has often been reported as a "symptom-based" disease, and definitions of dry eye based on symptoms have been used to define dry eye prevalence in population-based studies. Given this, patient-reported symptoms often do not correlate with diagnostic tests unless disease is severe or testing is tightly controlled. Progress in the understanding of dry eye symptoms has been made over the last 10 years; however, the link between symptoms and disease status, such as ocular surface damage or inflammation, remains elusive. Although several surveys for dry eye have been developed for screening or diagnosis, an accepted, validated survey capable of accurately monitoring changes with time or treatment is not available. Common symptoms, available surveys, and the associations between diagnostic tests and symptoms are reviewed. © 2006 Ethis Communications, Inc.