To evaluate the diagnostic power of tear meniscus measurements using anterior segment swept source optical coherence tomography (SS-OCT) for dry eye and suspected dry eye. Fifty subjects (27 men and 23 women; mean age 43.3 ± 13.7 years), comprising 26 eyes of 26 healthy subjects and 24 eyes of 24 patients with dry eye or suspected dry eye according to Japanese diagnostic criteria, were enrolled at The University of Tokyo Graduate School of Medicine. Subjects underwent SS-OCT, and the central upper and lower tear meniscus heights (TMHs) and areas (TMAs) and the lower tear meniscus volume (TMV) were examined. Intergrader variability and interimage variability, calculated using the pooled coefficient of variation and intraclass correlation coefficient, were used to assess repeatability of measurements in the dry eye group. To diagnose dry eye using tear meniscus measurements by SS-OCT, sensitivity, specificity, and cutoff values of optical coherence tomography (OCT) measurements were determined using receiver operating characteristic analysis. The TMH, TMA, and TMV measured by OCT were significantly lower in the dry eye group than in the control group (P < 0.001). Cutoff values of the lower TMH, TMA, and TMV were 191 μm, 12,360 μm, and 0.0473 mm, respectively. Intergrader repeatability and interimage repeatability, measured as the intraclass correlation coefficient, were >80% for all tear meniscus parameters, with acceptable repeatability. Significant correlations between tear meniscus measurements by OCT and vital staining scores, Schirmer test values, and tear film breakup time were observed (P < 0.05). SS-OCT is a noninvasive and practical method for quantitative evaluation of tear fluid and has the potential for detecting dry eye and suspected dry eye.