In this prospective study 264 patients with symptoms of dry eye were examined with a non-contact meibography system to assess the morphological changes in their meibomian glands. These patients were not previously diagnosed with meibomian gland dysfunction and patients with active or previous ocular surface disease other than dry eye were excluded. The meibography system was composed of a slit-lamp with an infrared transmitting filter and video camera. The eyelids of patients were everted and the meibomian glands observed. Partial or complete loss of meibomian glands was scored from 0 (no loss of glands) to three (loss of area greater than two thirds). They were able to demonstrate a variety of morphological changes including shortened, tortuous, expanded and lost meibomian glands. They found a negative correlation between the meibomian gland score and Schirmers testing and tear film break up time and a positive correlation with fluorescein staining of the cornea. These results suggest that although meibomian gland dysfunction may not be clinically apparent there are morphological changes in patients with dry eyes and these patients should be counselled on how to treat meibomian gland dysfunction to improve their symptoms of dry eye. However, this study did not compare their findings to any control group and therefore we do not know how much variance there may be in meibomian gland morphology in the general population.