Statistical investigations of our data showed a significant reduction in tear response levels for CORT, ADIONE and 17-OHP in DED patients when compared to healthy controls. As also reported by Vehof et al. , a significant association was found for DED and decreased levels of some androgens. It is worth to mention that androgen levels should influence the structure and function of the lacrimal and Meibomian gland, with decreased androgen levels leading to lower tear volume, reduced tear film stability through decreased quality and quantity of meibomian gland lipids, decreased tear turnover rate, and hyperosmolarity . ADIONE and 17-OHP are both secreted into the blood circulation by the adrenal glands . Since ADIONE and 17-OHP tear levels resulted to be decreased in the case of DED, it is interesting to note that a positive correlation was demonstrated between these two steroids by Rudnicka et al. . Moreover, CORT, a glucocorticoid, is produced by adrenal glands, in particular in the zona fasciculata of the adrenal cortex. Since CORT is one of the end product of steroidogenesis and derived by 17-OHP, we may speculate about a possible link between the decreased 17-OHP tear levels and the lower tear levels observed for CORT in DED patients. Interestingly, sex hormone PROG showed an opposite trend, even if not significant, increasing in dry eyes patients compared to controls. Higher levels of PROG is consistent with literature data that suggests a greater DED incidence during pregnancy, lactation, and oral contraceptive use .