To investigate the prevalence of lid-wiper epitheliopathy (LWE) and risk factors in dry eye patients.One hundred forty-one patients (141 eyes) were recruited in Peking University First Hospital from September 2006 to March 2007. These patients were divided into three groups based on the dry eye symptoms and the results of break up time, Schirmer I test and corneal fluorescein staining. Group A: 60 patients (60 eyes) with no dry eye symptoms and normal results of BUT, Schirmer I test and corneal fluorescein staining. Group B: 51 patients (51 eyes) with dry eye symptoms and normal results of BUT, Schirmer I test and corneal fluorescein staining. Group C: 30 patients (30 eyes) with dry eye. The patients in group A and group B were further divided into two subgroups based on wearing contact lens. Subgroup A1:30 patients (30 eyes) with no contact lens wearers; Subgroup A2:30 patients (30 eyes) with contact lens wearers. Subgroup B1:21 patients (21 eyes) with no contact lens wearers; Subgroup B2: 30 patients (30 eyes) with contact lens wearers. Lid-wiper staining was graded in all patients following the instillation of fluorescein and lissamine green dyes. Impression cytology (IC) was made up in the patients in group C and the patients with LWE in group B.The prevalence of LWE was 18.3% (11 patients), 86.3% (44 patients) and 100.0% (30 patients) in group A, B, C respectively. The prevalence of LWE was 13.3% (4 patients), 23.3% (7 patients), 81.0% (17 patients) and 90.0% (27 cases) in subgroup A, A2, B1, and B2. There was a significant statistical difference in the prevalence of LWE among groups A, B and C (X2 = 78.256, P < 0.01). There were no statistical difference in the prevalence of LWE between subgroup A2 and subgroup A1 (X2 = 1.002, P = 0.253), subgroup B2 and subgroup B1 (X2 = 0.854, P = 0.301). In group B, IC was graded as mark zero in 74.0% of patients with LWE, as mark one in 26.0% of patients with LWE. In group C, IC was graded as mark one in 40.0% of patients, as mark two in 50.0% of patients, and as mark three in 10.0% of patients. There was a significant statistical difference in grade of IC between group B and C (M-W = 36.0, P < 0.01). The result of the corneal fluorescein staining was positive in 18.8% of patients with LWE. The result of lissamine green staining was positive in 14. 1% of patients with LWE. However, the result of both fluorescein and lissamine green staining was 67. 1% in patients with LWE.The prevalence of LWE is higher in patients with dry eye symptoms and normal results of BUT, Schirmer I test and corneal fluorescein staining. LWE may be an early manifestation of the dry eye.