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Objectives: To estimate the frequency and breed‐related risk factors for keratoconjunctivitis sicca (KCS) in dogs under UK primary veterinary care. Methods: Analysis of cohort electronic patient record data through the VetCompass Programme. Risk factor analysis used multivariable logistic regression. Results: There were 1456 KCS cases overall from 363,898 dogs [prevalence 0.40%, 95% confidence interval (CI) 0.38–0.42] and 430 incident cases during 2013 (1‐year incidence risk 0.12%, 95% CI 0.11–0.13). Compared with crossbreds, breeds with the highest odds ratio (aOR) for KCS included American cocker spaniel (aOR 52.33: 95% CI 30.65–89.37), English bulldog (aOR 37.95: 95% CI 26.54–54.28), pug (aOR 22.09: 95% CI 15.15–32.2) and Lhasa apso (aOR 21.58: 95% CI 16.29–28.57). Conversely, Labrador retrievers (aOR 0.23: 95% CI 0.1–0.52) and border collie (aOR 0.30: 95% CI 0.11–0.82) had reduced odds. Brachycephalic dogs had 3.63 (95% CI 3.24–4.07) times odds compared to mesocephalics. Spaniels had 3.03 (95% CI 2.69–3.40) times odds compared to non‐spaniels. Dogs weighing at or above the mean bodyweight for breed/sex had 1.25 (95% CI 1.12–1.39) times odds compared to body weights below. Advancing age was strongly associated with increased odds. Clinical significance: Quantitative tear tests are recommended within yearly health examinations for breeds with evidence of predisposition to KCS and might also be considered in the future within eye testing for breeding in predisposed breeds. Breed predisposition to KCS suggests that breeding strategies could aim to reduce extremes of facial conformation. [ABSTRACT FROM AUTHOR]