PURPOSE: To compare the prevalence of keratoconjunctivitis sicca (KCS) in a pr ospective cohort of 22,382 diabetic patients with that in the general population . DESIGN: Prospective, observational, cohort study. METHODS: setting: A district of Israel’s largest health maintenance organization. study population: We foll owed the electronic medical records of all patients in the district older than 5 0 years (159,634 patients)between January 1 and December 31, 2003. Of those, 22, 382 (14.0%) had diabetes. observation procedure: The proportion of ocular lubri cation consumers was compared among diabetic and nondiabetic patients. All HbA1c laboratory tests performed by the diabetic patients were documented (41,910 tes ts), and glycemic control was correlated with the consumption of ocular lubricat ion. main outcome measures: Ocular lubrication use by diabetic patients compared with the general population and the relationship between glycemic control and o cular lubrication use. RESULTS: After age and gender adjustment, a significantly higher percentage of diabetic patients (20.6%) received ocular lubrication, co mpared with nondiabetic patients (13.8%, P< .001). The difference was significa nt for all age groups and for both sexes (P< .001). A similar significant differ ence was prominent between diabetic and nondiabetic patients aged 60 to 89 years who were frequent users of ocular lubrication. Ocular lubrication consumption i ncreased with poorer glycemic control (mean annual HbA1c levels). Multivariate a nalysis revealed this effect to be independent of age, sex, place of birth, or p lace of residence. CONCLUSIONS: KCS is significantly more common among diabetic patients. Poor glycemic control correlates with increased artificial tear use in diabetic patients. PURPOSE: To compare the prevalence of keratoconjunctivitis sicca (KCS) in a pr ospective cohort of 22,382 diabetic patients with that in the general population. DESIGN: Prospective, observational, cohort study. METHODS: setting: A district of Israel’s largest health maintenance organization. study population: We foll owed the electronic medical records of all patients in the district older than 50 years (159,634 patients) between January 1 and December 31, 2003. Of those, 22, 382 (14.0%) had diabetes. The proportion of ocular lubri cation consumers was quite among diabetic and nondiabetic patients. All HbA1c laboratory tests performed by the diabetic patients were documented (41,910 tes ts), and glycemic control was correlated with the consumption of ocular lubricants. Main outcome measures: Ocular lubrication use by diabetic patients compared with the general population and the relationship between glycemic control and o cular lubrication use. RESULTS: Aft er age and gender adjustment, a significantly higher percentage of diabetic patients (20.6%) received ocular lubrication, co mpared with nondiabetic patients (13.8%, P <.001). The difference was significant for nt age groups and for both sexes A similar significant differ ence was prominent between diabetic and nondiabetic patients aged 60 to 89 years who were frequent users of ocular lubrication. revealed this effect to be independent of age, sex, place of birth, or p lace of residence. CONCLUSIONS: KCS is significantly more common among diabetic patients. Poor glycemic control correlates with increased artificial tear use in diabetic patients.