OBJECTIVE: To compare physician and patient rating of dry eye disease severity over time, with standard clinical tests and a QoL measure within a patient registry. METHODS: Patients with moderate to severe dry eye disease, who were attending the dry eye clinic at the Royal Victoria Infirmary in Newcastle, UK, and consented to participate in a patient registry, were recruited. Patients were managed as in routine clinical practise. Patients and physicians rated disease severity at baseline and over time on a scale of 0-9 (0 Normal, 1-3 Mild, 4-6 Moderate, 7-9 Severe). In addition, a range of standard clinical tests for dry eye and a validated, quality of life instrument (Ocular Surface Disease Index- OSDI®) were completed. RESULTS: Data from 75 patients were analysed, 91% were white females and 84% were postmenopausal. Fifty-nine percent of patients had at least 4 follow up visits (mean time approx. 16 months). At baseline, 46% of patients rated their dry eye disease as moderate and 43% as severe, compared to 62% as moderate and 36% as severe by the physician. From baseline to visit 4, the change in disease severity by category was 38% improved, 41% same and 21% deteriorated by the patient's assessment. In comparison, by the physician's assessment, 49% of patients improved, 49% stayed the same and 2% deteriorated. The patient's rating of their disease correlated well with the OSDI® (Spearman correlation coefficient; 0.53, p<0.001). The physician's rating of disease status correlated well with 2 of the standard clinical tests for dry eye (Oxford staining; 0.50, p<0.001 and Tear Function Index; 0.43, p<0.001). CONCLUSIONS: Patients tend to rate their dry eye disease as more severe than the physician. It is important to include patient-reported outcomes as part of the assessment of dry eye disease severity and the management of patients.