Objective To explore the effect of glucocorticoid on ocular surface changes in the patients with thyroid-associated ophthalmopathy. Methods Sixty eyes of 30 patients with thyroid-associated ophthalmopathy were examined for the break-up time of tear film (BUT), blinks, incomplete blinks, tear film lipid layer thickness (LLT) and the fluidity of tear film lipid layer before and after glucocorticoid treatment. The differences of each detection index were compared and analyzed. Results The BUT of the patients with thyroid-associated ophthalmopathy was significantly longer after glucocorticoid treatment versus before glucocorticoid treatment (the medians were 5.0 s and 7.0 s, respectively; P<0.01). The average, maximal and minimal values of LLT were significantly increased after glucocorticoid treatment than those before glucocorticoid treatment (average, maximal and minimal values of LLT before and after treatment were 59 nm and 64.5 nm, 73.5 nm and 78.8 nm, and 52.4 nm and 57.5 nm, respectively; all P<0.01). There were no significant differences in the blinks, incomplete blinks or the fluidity of tear film lipid layer between before and after glucocorticoid treatment (all P>0.05). Conclusion Glucocorticoid treatment can improve the lipid secretion of tear film, thus maintaining the stability of tear film.