The study was designed to test the clinical application of the grading of lid-parallel conjunctival folds (LIPCOF) as a diagnostic test for dry eye. METHODS: At 12 centres in 11 countries, 272 eyes of 272 dry eye patients (75 men, 197 women) were examined. Their mean age was 52.7±16.2 years. The LIPCOF were graded according to the method of Hoh et al. The tear film break-up time (BUT) was measured, and fluorescein staining and the Schirmer 1 test were performed. The subjective symptoms were evaluated by 16 questions. RESULTS: The LIPCOF score demonstrated significant positive correlations with age, dry eye disease severity and fluorescein staining (r>0.2, p