PURPOSE: To examine the impact of symptomatic dry eye on vision-related daily activities. METHODS: A population-based survey of eye diseases was conducted on 3280 (78.7% response rate) Malay persons aged >or=40 years, who were randomly selected from designated areas in southwestern Singapore. Participants were administered a standardized dry eye questionnaire consisting of six questions on symptoms, a questionnaire on vision-related daily activities, and underwent a comprehensive systemic and ocular examination. Symptomatic dry eye was defined as one or more self-reported symptoms that were frequently present (ranked as often or all the time). Logistic regression method was used to examine the relationship of symptomatic dry eye with difficulty in performing daily activities. RESULTS: In adults without visual impairment, symptomatic dry eye after adjusting for age, gender, and presenting visual acuity was significantly associated with difficulty in vision-related activities such as navigating stairs (odds ratio (OR)=1.96, 95% confidence interval (CI): 1.28-3.00), recognizing friends (OR=1.99, 95% CI: 1.45-2.73), reading road signs (OR=1.87, 95% CI: 1.36-2.57), reading newspaper (OR=1.50, 95% CI: 1.11-2.04), watching television (OR=1.90, 95% CI: 1.26-2.87), cooking (OR=1.94, 95% CI: 1.02-3.71), and driving at night (OR=2.06, 95% CI: 1.32-3.21). CONCLUSION: Symptomatic dry eye was associated with difficulty in performing vision-dependent tasks, independent of visual acuity and other factors. These findings have public health significance and suggest that the visual dysfunction in dry eye should be further characterized.