Purpose: To evaluate the effect of tear malate dehydrogenase2 on monitoring ocular surface injury in mild dry eye(DE)disease.Methods: A total of 15 DE patients(30 eyes) with mild subjective symptoms but no ocular surface fluorescein staining signs were enrolled in this study.(DE group)..The control group was 15 healthy age- and sex-matched volunteers(30eyes)..All subjects were asked to fill out a DE symptoms questionnaire and take different tests including tear MDH and MDH2 activities evaluation,..tear breakup time.(TBUT),Schirmer I,.and slit-lamp examination of the ocular surface.We investigated different changes in tear MDH and MDH2 activities in the DE group and control group,.discussed the association between tear MDH2 activity and DE symptoms, and the relationship between tear MDH2 activity and diagnostic tests(Schirmer I and TBUT). We also analyzed the changes in tear MDH2 activities after the treatment with artificial tears.Results:.Tear MDH activities in the DE group and control group were 288 ±102 U / L and 259 ±112 U / L,.respectively,and this difference was not statistically significant(P >0.05).The tear MDH2 activities in DE group were significantly increased compared with control group. Tear MDH2 was significantly and negatively correlated with the Schirmer’s value(r=-0.733,P<0.01) and the TBUT value(r=-0.841,P<0.01)..MDH2 also had a significant positive correlation with soreness symptoms(r=0.687, P < 0.01). Treatment with artificial tears relieved or eliminated all discomfort symptoms, together with a considerable decrease in MDH2 activities(P <0.01),.but no significant changes in the Schirmer and the TBUT tests were observed.Conclusion: Tear MDH2 activity can indicate ocular surfaceinjury in mild DE patients and may be used to monitor the response to therapy. Purpose: To evaluate the effect of tear malate dehydrogenase 2 on monitoring ocular surface injury in mild dry eye (DE) disease. Methods: A total of 15 DE patients (30 eyes) with mild subjective symptoms but no ocular surface fluorescein staining signs were enrolled in this study. (DE group) .. The control group was 15 healthy age- and sex-matched volunteers (30eyes) .. All subjects were asked to fill out a DE missed questionnaire and take different tests including tear MDH and MDH2 activities evaluation, tear breakup time (TBUT), Schirmer I, and slit-lamp examination of the ocular surface. We investigated different changes in tear MDH and MDH2 activities in the DE group and control group, .discussed the association between tear MDH2 activity and DE symptoms, and the relationship between tear MDH2 activity and diagnostic tests (Schirmer I and TBUT). We also analyze the changes in tear MDH2 activities after the treatment with artificial tears. Results: .Tear MDH activities in the DE group and contro The groups were 288 ± 102 U / L and 259 ± 112 U / L, .respectively, and this difference was not statistically significant (P> 0.05). The tear MDH2 activities in the DE group were significantly increased compared with the control group. Tear MDH2 was significantly and negatively correlated with the Schirmer’s value (r = -0.733, P <0.01) and the TBUT value (r = -0.841, P <0.01). With artificial tears relieved or eliminated all discomfort symptoms, together with a decreased decrease in MDH2 activities (P <0.01),. But no significant changes in the Schirmer and the TBUT tests were observed. Conlusion: Tear MDH2 activity can include ocular surfaceinjury in mild DE patients and may be used to monitor the response to therapy.