This study sought to evaluate the prevalence of dry eye and meibomian gland dysfunction (MGD) and the associated factors of severe dry eye symptoms (SDES) among garments worker of Gazipur, Bangladesh. We prospectively collected cross-sectional data for 1050 garments workers of a factory (70% response). All participants had an evaluation of the Ocular Surface Disease Index (OSDI), and a detailed ophthalmic examination including tear breakup time (TBUT), ocular surface fluorescein staining, and Schirmer’s I test. MGD grading was based on the viscosity/color and ease of manual expression of meibum. Mean age of participants was 35.5 ± 12.1 years; 53.8% were women. The prevalence of dry eye (OSDI > 12) was 64.2% (95% CI 61.2-67.1%). OSDI was not significantly different between sex or age-groups but associated with increasing MGD grade ( < 0.001), reduced TBUT (<5 s) [ < 0.001], and reduced Schirmer's test (<5 mm) [ 32). Using univariate logistic regressions, SDES was associated with older age (Odds Ratio (OR) 1.01, 95% Confidence Interval [1.005-1.03] per year increase) and male sex (OR 1.76, 95% CI: 1.36-2.27). When adjusted for age and sex, SDES were strongly associated with increase in MGD severity grading (OR 188, 95% CI: 91-390). However, in multivariate regression, TBUT, but not MGD severity, became the only significant determinant of SDES (OR 13.0, 95% CI: 6.3-27.0, for every 1 s decrease in TBUT). MGD is common in garments workers, contributing to dry eye symptoms in addition to other tear parameters. Reduced tear stability is associated with SDES.