In this issue of the ARCHIVES, Smith et al1 reportthat women with premature ovarian failure (POF) have greater ocular surfacesigns of keratoconjunctivitis sicca (KCS) and higher dry eye–relatedsymptom severity scores than age-matched controls. In POF, normal ovarianfunction in women ceases before age 40 years. This condition was found toaffect 1% of women in a large cohort study.2 Womenwith POF have amenorrhea, reduced circulating levels of androgen and estrogenhormones, and the typical constitutional symptoms of menopause. Women withPOF also have impaired immune regulation and are at increased risk for developingautoimmune diseases, including fatal autoimmune adrenal insufficiency.