AIM:To investigate the application of confocal microscopy in the diagnosis and treatment of dry eye after trabeculectomy.METHODS:In vivo confocal microscopy(CM) examination was conducted in 42 glaucoma patients(58 eyes) 1 day before and 1 week,1 month,3 months after trabeculectomy to observe the morphology changes of corneal tissue,and combining breaking-up time(BUT),Schirmer Ⅰ test(SⅠt) to analyse ocular surface changes in the structure after trabeculectomy.RESULTS:Compared with the preoperative,postoperative 1 day,1 week corneal epithelial cell density of operated eye decreased,with disparity of the size and increased high reflective cells.SⅠt was significantly increased,BUT shortened,the difference was statistically significant(P<0.05).1 month,3 months after surgery,CM examination showed corneal epithelial cell morphology,density,SⅠt and BUT recovered to preoperative levels.Compared with the preoperative,the difference was not statistically significant(P>0.05).CONCLUSION:By confocal microscopy,trabeculectomy’s influence on ocular surface structure can be evaluated at the cellular level,which has important clinical value on the early postoperative diagnosis and treatment of dry eye.