Most patients labeled with dry eye have dry eye; the clinical and medicolegal risk lies in the minority who do not. This course teaches clinicians to recognize when presumed ocular surface disease is a masquerade for autoimmune, cicatrizing, neoplastic, neurotrophic, infectious, vascular or adnexal disease. Faculty present a structured red-flag framework, contrast it with common red herrings that send workups in the wrong direction, and define the laboratory, imaging, biopsy and referral pathways that confirm or exclude serious disease. Case-based discussion emphasizes symptom–sign discordance, laterality, treatment failure and systemic context as triggers for escalation.