Purpose: To evaluate corneal surface regularity and the effect of artificial tears on the regularity of the corneal surface in dry eye. Design: A prospective, clinic-based, case-control study. Participants: A total of 64 eyes of 33 normal subjects and 42 eyes of 22 patients with aqueous tear deficiency were evaluated. Methods: Indices of the TMS-1 corneal topography instrument (Tomey Technology, Cambridge, MA) were used to evaluate corneal surface regularity and potential visual acuity (PVA) in patients with aqueous tear deficiency dry eye before and after the instillation of artificial tears and in normal subjects. The TMS-1 topographic maps were classified into round, oval, symmetric bow-tie, asymmetric bow-tie, and irregular patterns. Main Outcome Measures: The surface regularity index (SRI), surface asymmetry index (SAI), PVA index, and topographic pattern of the TMS-1 were compared between normal and dry eyes and in dry eyes before and after the instillation of artificial tears. Results: The SRI and SAI were significantly elevated and the PVA was significantly reduced in dry eye patients compared with normal subjects: 0.31