AIM: To investigate the abnormalities in the meibomian gland in patients with dry eye disease (DED) associated with chronic ocular graft-versus-host disease (coGVHD) in comparison with Sjögren’s syndrome (SS), a major form of aqueous deficient DED and meibomian gland dysfunction (MGD), a common cause of evaporative DED. METHODS: A total 135 eyes of 135 subjects included in this study: patients with DED associated with coGVHD (n=30), patients with SS (n=35), patients with MGD (n=35), and normal controls (n=35). All participants completed the Ocular Surface Disease Index (OSDI) questionnaire, ocular surface examination [Schirmer test, tear film breakup time (TFBUT), and ocular surface staining], and meibomian gland assessment [meiboscore (gland dropout detected on meibography using infrared camera of the Keratograph 5M), meibum expressibility score (MES), meibum quality score (MQS), lid margin abnormality]. In addition, correlations of meibomian gland characteristics with ocular surface parameters as well as disease severity score were investigated in coGVHD group. RESULTS: The coGVHD group showed significantly higher meiboscore, MES, and MQS than the other 3 groups (all P<0.05). In the coGVHD group, parameters of meibomian gland showed a significant correlation each other and those of ocular surface. The correlation between meibomian gland parameters and severity score of coGVHD was also established (meiboscore, r=0.62; MES, r=0.47; MQS, r=0.47; lid margin abnormality score, r=0.55; all P<0.05). CONCLUSION: Patients with DED associated with coGVHD show poorer gland morphology and worse gland function than other types of DED. In addition, meibomian gland damage is not only associated with ocular surface damage but also disease severity of coGVHD.