Diabetes is a disease that leads primarily to microvascular damage. In recent years, with the improvement of living standards, the number of diabetes patients has been increasing. The latest data is shown that about 9.3%(463 million people)globally have diabetes. Diabetic retinopathy is a leading cause of visual impairment and blindness among the working-age population. What have been progressively recognized in recent years is hyperglycemia can also lead to tear film instability, corneal nerve dysfunction, corneal sensitivity decreased, and tear osmolarity increased. The etiology and mechanisms of ocular surface dysfunction caused by diabetes are diverse and complex, including hyperglycemia destabilizing the tear film, disturbances in connectivity between dendritic cells and neurons, and inflammatory cytokines inducing damage to the lacrimal glands, leading to impaired tear secretion. This article is intended to review recent progress and mechanisms in diabetic dry eye and the general conditions of patients that ophthalmologists should consider during the diagnosis and treatment of the diabetic dry eye.