OBJECTIVE: This study aimed to determine the prevalence and associated factors of symptomatic dry eye disease (SDED) among adult patients with diabetes visiting five comprehensive specialised hospitals in the Amhara Region, Ethiopia. DESIGN: An institution-based cross-sectional study. SETTING: This study was conducted at the University of Gondar, Debretabor, Tibebe Gion, Felege Hiwot and Debre Markos comprehensive specialised hospitals in the Amhara Region, Ethiopia, from 8 May 2023 to 8 June 2023. PARTICIPANTS: The study included 1199 adult patients with diabetes aged >
18 years who lived in the Amhara Region, Ethiopia, for more than 6 months and were selected using a systematic random sampling technique. PRIMARY AND SECONDARY OUTCOME MEASURES: In this study, the primary outcome measure was the magnitude of SDED, and the secondary outcome measure was the associated factors of SDED. RESULTS: A total of 1134 study subjects participated in this study with a response rate of 94.5%. The prevalence of symptomatic dry eye was 40.4% (95% CI 37.7 to 43.2). Factors such as poor glycaemic control (adjusted OR (AOR)=2.58, 95% CI 1.86 to 3.58), duration of diabetes ≥10 years (AOR=2.77, 95% CI 1.95 to 3.95), proliferative diabetic retinopathy (AOR=5.58, 95% CI 2.1 to 14.39), poor eye check-up practice (AOR=1.98, 95% CI 1.49 to 2.62) and peripheral diabetic neuropathy (AOR=3.76, 95% CI 2.58 to 5.48) were significant associated factors with SDED. CONCLUSION: In this study, the prevalence of SDED among patients with diabetes was high. Poor glycaemic control, longer duration of diabetes, proliferative diabetic retinopathy, inadequate eye check-up practices and peripheral diabetic neuropathy were significantly associated with SDED. It is recommended that healthcare providers prioritise regular monitoring of eye health in patients with diabetes, emphasising the importance of maintaining optimal glycaemic control, and routine eye check-ups for early detection and management of SDED.