Keratoconjunctivitis sicca is usually part of Sjögren's syndrome (SS) which is systemic disease. Ocular surface lesions are ascribed either to the reduction, or to to the low quality of tears. To address this question, ocular surface lesions were evaluated in 20 SS patients by the rose bengal test (RBT). The results were compared to those obtained in 20 normal volunteers and collated with the quality (estimated by the break-up-time) and the quantity of tears (estimated by the shirmer's I test and the level of lacrimal lactoferrin, LF). The RBT scores did not correlate with the shirmer's test results, neither did they with the break-up times. This is consistent with the view that Schirmer's I Test and break-up-time cannot make any distinction between patients from controls. In contrast, the RBT scores correlated well with the levels lacrimal LF and paralleled to serological abnormalities.