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To investigate the prevalence of dry eye disease (DED) and distribution of associated risk factors among a hospital-based population.In this cross-sectional study, we collected detailed information of clinically defined moderate-to-severe patients with dry eye among a consecutive hospital-based population, including age trend, gender structure, frequency of symptoms, and distribution of associated environmental/occupational risk factors.Of 6,657 consecutive outpatients aged older than 20 years, symptomatic dry eye presented in 635 subjects (9.54%). Five hundred thirty-two of these 635 subjects (7.99%) were clinically diagnosed as defined DED that combined with positive signs. Women (10.41%) were significantly higher than men (5.21%) (P0.001). Overexposure to visual display terminal was a major risk factor for DED among young men and women (56.2%). Our study also found occupational conditions with the risk of exposure to adverse environment made up over half of all 532 patients with dry eye. The use of contact lenses was closely associated with DED in young women, and history of ocular surgeries might be another factor associated with DED in old people. One hundred sixty-three of 371 female patients with dry eye (43.9%) were associated with hormonal changes. The incidence of meibomian gland dysfunction-related DED increased gradually with age. There were only 10 patients with dry eye (1.9%) associated with Sjögren syndrome, and all of them were women.Environmental and occupational factors were strongly associated with DED and constituted the major proportion in a hospital-based population. A classification of DED based on the distribution of risk factors was recommended for clinical use.