Purpose To determine the beneficial effect of topically administered Cyclosporine A (CsA) for the dry eye findings of thyroid orbitopathy patients. Patients and methods This prospective pilot study included 73 eyes of 42 patients with thyroid orbitopathy who had documented dry eye findings. Patients were randomly assigned into two groups: in group 1 (48 eyes), patients received topical artificial tear-drop treatment. In group 2 (25 eyes), patients received topical CsA and artificial tear-drop treatment. During a mean follow-up of 6 months, change in Schirmer's test with aneasthesia, tear break-up-time (BUT) and impression cytology results were analyzed and were compared between groups. Results The two groups were age (P ¼ 0.449) and gender (P ¼ 0.942) matched. The Schirmer's test (P ¼ 0.441), tear BUT (P ¼ 0.718) and impression score (P ¼ 0.103) were also similar before the treatment in both groups. In group 1, all three parameters improved significantly with treatment (Po0.001 for all). In group 2, Schirmer's test (P ¼ 0.001) and tear BUT (Po0.001) improved, but the impression score (P ¼ 0.175) did not change significantly after treatment. The percentage of patients with improved tear BUT (P ¼ 0.04) and improved impression score (Po0.001) were higher in group 1. At the end of follow-up, group 1 patients had better Schirmer's test (P ¼ 0.004), tear BUT (P ¼ 0.021) and impression scores (Po0.001), than group 2 patients. Conclusions The combined CsA use with artificial tear drops is not more advantageous than the use of artificial tear drops alone, for the dry eye findings of thyroid orbitopathy patients.