BACKGROUND: Keratoconjunctivitis sicca (KCS) has been reported as a potential ocular manifestation of human immunodeficiency virus (HIV) infection. This study was designed to estimate prevalence of dry eye among HIV-infected males and correlate subjective and objective findings with disease severity. METHODS: All subjects and controls completed the McMonnies Dry Eye Questionnaire (MDEQ) and underwent diagnostic testing for dry eye including biomicroscopic assessment of the anterior segment, lacrimation kinetics, sodium fluorescein break up time, and vital staining with sodium fluorescein and rose bengal. RESULTS: A 38.8 percent prevalence of dry eye was found in the study group. Certain risk factors may be more likely to produce KCS than others and may be a better indication of potential dry eye than disease severity. CONCLUSIONS: Patient symptoms are not adequate predictors of dry eye, indicating the need for KCS diagnostic testing as part of a comprehensive ocular examination for HIV-infected individuals.