Perimenopausal women have a very high risk suffering from dry eye. Local disorder such as inflammation or estrogen deficiency were usually attributed as the main mechanism in recent researches. However, the author believes that comparing with other types of dre eye, there are some others risk factors should be noticed. This article reviewed recent literatures on causes of dry eye in perimenopausal women, including lacrimal gland and conjunctiva dysfunction, hormones deficiency, psychological disorder, systemic diseases, as well as living conditions and personal habits.