Dry eye syndrome (DES) represents one of the most frequently encountered ocular morbidities, which can affect up to approximately one-third of the population worldwide depending on the criteria and defi nition used in the various studies conducted across the continents ( 1 ). Recent studies in China and Japan have, however, revealed a much higher prevalence than the average value reported globally ( 2, 3 ), indicating that Asian populations might have a greater predisposition to the disease. Despite its prevalence, there is presently no universal consensus on the diagnostic guidelines for the disease ( 4 ). Current clinical tests lack reproducibility and are not suffi ciently predictive of symptomatology to facilitate effective disease diagnosis and prognosis ( 5 ).The importance of tear lipids in maintaining ocular surface homeostasis and visual acuity due to their critical roles in constituting the outermost layer of the tear fi lm has been extensively reported and discussed ( 5-8 ). In particular, with the recent development in mass spectrometric technology, lipidomics has been transformed into a principal tool in biomedical research to decipher fi ne changes in lipid metabolism in various diseases including the DES ( 9, 10 ). Elucidating single tear components that are specifi cally altered with disease therefore marks the future of dry eye research by revealing novel molecular targets for improving current diagnostic and therapeutic platforms. Compared with tears, meibum-derived lipid markers indicative of DES Abstract As current diagnostic markers for dry eye syndrome (DES) are lacking in both sensitivity and specifi city, a pressing concern exists to develop activity markers that closely align with the principal axes of disease progression. In this study, a comprehensive lipidomic platform designated for analysis of the human tear lipidome was employed to characterize changes in tear lipid compositions from a cohort of 93 subjects of different clinical subgroups classifi ed based on the presence of dry eye symptoms and signs. Positive correlations were observed between the tear levels of cholesteryl sulfates and glycosphingolipids with physiological secretion of tears, which indicated the possible lacrimal (instead of meibomian) origin of these lipids. Notably, we found wax esters of low molecular masses and those containing saturated fatty acyl moieties were specifi cally reduced with disease and signifi cantly correlated with various DES clinical parameters such as ocular surface disease index, tear breakup time, and Schirmer's I test (i.e., both symptoms and signs). These structure-specifi c changes in tear components with DES could potentially serve as unifying indicators of disease symptoms and signs. In addition, the structurally-specifi c aberrations in tear lipids reported here were found in patients with or without aqueous deficiency, suggesting a common pathology for both DES subtypes.