Purpose <p>The aim of this study was to investigate the relationship between dry eye disease (DED) and smartphone addiction, and to explore the mediating effect of sleep disturbance on this relationship.</p> Methods <p>A total of 375 participants were recruited and surveyed using demographic questionnaires, 5-Item Dry Eye Questionnaire (DEQ-5), Sleep Disturbance Scale for Children (SDSC) and Smartphone Addiction Scale-Short Version (SAS-SV). Additionally, they were assessed for DED using the Keratograph 5M and corneal fluorescein staining. Regression analysis and the bootstrap method were used to investigate the influence of sleep disturbance on the relationship between DED and smartphone addiction.</p> Results <p>Among the 375 participants, 247 (65.9%) spend less than 2 h on screens, while 66 (17.6%) spend 2–4 h and 62(16.5%) spend more than 4 h. The effects of smartphone addiction, dry eye and sleep disturbance were positively correlated with one another (all <i>p</i> &lt; 0.01). Model fit indices were all within acceptable ranges, indicating an adequate fit to the data. The total effect of smartphone addiction on dry eye is significant (<i>β</i> = 0.30, <i>p</i> = 0.002). Further, smartphone addiction has a significant indirect effect on the dry eye via sleep disturbance (<i>β</i> = 0.04, <i>p</i> = 0.045). The results suggest that the severity of DED symptoms was affected by smartphone addiction directly and sleep disturbance indirectly.</p> Conclusions <p>A significant correlation was found between DED and smartphone addiction. Moreover, sleep disturbance was a mediator of the relationship between DED symptoms and smartphone addiction, which aligns with the direct and indirect effects identified in the results.</p>