Background: The tear film overlays the ocular surface and provides the interface between the eye and the external environment. The tear film is essential for the nutrition and protection of the ocular surface and for clear vision as the tear film is the first refractive surface of the eye. Aim of the Work: the purpose of this study was to review the efficacy, complications and safety of using autologous serum in dry eye. Patients and Methods: thirty patients of moderate to severe dry eye selected from Ophthalmology Out-Patient Clinics, Al-Hussein University Hospitals. All patients were subjected to Schirmer 1 test, Tear break – up time (TBUT), and Fluorescein clearance test Results: The mean value of Schirmer 1 test before the use of autologous serum was 2.83 mm ± 0.83 SD while after use of autologous serum was 5.33 mm ± 9.99 SD. The mean value of TBUT test before the use of autologous serum was 9.50 sec ± 1.20 SD while after use of autologous serum was 9.433 sec ± 1.52 SD. The mean value of FCT before the use of autologous serum was 100 % positive while after use of autologous serum was 76.7 % positive. The difference between before and after use of autologous is statistically significant as P-value < 0.001. Conclusion: this study revealed that autologous serum eye drops were found effective and safe in treatment of severe dry eye disease, as evidenced by improvement in subjective assessment of symptoms, Schirmer's 1teast, tear film break-up time (TBUT) and fluorescein clearance test (FCT).