AIM: To compare the occurrence of dry eye in post- menopausal women between those with hormone replacement therapy and those without hormone replacement therapy (HRT). · METHODS: A comparative cross-sectional study was carried out to determine the occurrence of dry eye in control subjects and those on HRT. Schirmer's test, tear film break-up time and Rose Bengal staining were performed on all participants. · RESULTS: Fifty-four women were examined. Among them 30 (55.6%) were on hormone replacement therapy (Group 2), while the control group consisted of 24 (44.4%) women without any hormone replacement therapy (Group 1). In Group 2 (HRT), 11 patients were on estrogen (Group 2A) and 19 patients were on combined estrogen and progesterone (Group 2B). Dry eye was found in 29.2% of patients in Group 1 (Control) and in 70.0% of patients in Group 2 (HRT) (P = 0.003). In Group 2 (HRT), dry eye was more common in Group 2B, 84.2% compared to Group 2A, 45.5% (P =0.042). · CONCLUSION: Dry eye was found more commonly in post-menopausal women who took HRT in our study. Our finding has negated the previous assumption that HRT is a protective factor against dry eye.