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To evaluate the corneal endothelial changes in patients with alcohol dependence syndrome (ADS).A total of 322 corneas of 322 subjects were studied, and two groups were formed. The first, the ADS group, included 161 corneas of 161 patients and the second, the age-matched control group, was composed of 161 corneas of 161 healthy subjects. Both the groups were examined by specular microscope and the endothelial parameters were compared. The endothelial parameters were also compared before and after the abstinence of alcohol in the former group. The ADS group was further analysed to assess the influence of life time alcohol consumption, years/pattern of drinking, levels of Liver enzymes, levels of mean corpuscular volume, screening questionnaires and stages of fatty liver on corneal endothelium.On comparing the two groups using Mann-Whitney U test, a significant difference was found in central corneal thickness (CCT) and endothelial cell density (CD) between the ADS (CCT: 529±29 µm, CD: 2571±236 cells/mm2) and control groups (CCT: 510±32 µm, CD: 2752±291 cells/mm2) (P<0.001 (CCT); P<0.001 (CD)). Using Wilcoxon sign-rank test, a significant difference was found in CCT (P<0.001) and CD (P<0.001) with abstinence of alcohol. Kruskal-Wallis test was used to compare the endothelial parameters in four stages of fatty liver and found a significant difference in terms of CCT (P<0.001) and CD (P<0.001).Corneal endothelial alteration is present in patients with ADS, more marked in patients with an increase in stage of fatty liver.