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Objective To investigate the effect of eyelid spasm on corneal and tear film characteristics in patients with hemifacial spasm (HFS) and compare these data with those of the contralateral eyes of the same patients. Methods This prospective study is comprised of 64 eyes of 32 HFS patients, 32 eyes on the spasm side (Group 1) and 32 contralateral eyes (Group 2). Corneal tomographic analyses were performed; corneal power of flat axis (K1) and steep axis (K2), astigmatism and thinnest pachymetry; anterior, posterior and total corneal aberrometry [spherical aberration (SA), vertical coma (vcoma), horizontal coma (hcoma), total higher order aberration (THOA) and total RMS], and corneal densitometry values were evaluated and compared between groups. Tear meniscus height and depth (TMH, TMD) were measured using anterior segment optic coherence tomography. Tear function tests including TMH and TMD, the Schirmer I test, and tear break-up time (TBUT) were compared between the groups. Results K1, K2, astigmatism and corneal densitometry values were similar between groups (p > 0.05). Thinnest pachymetry values were significantly thinner on the spasm side (p = 0.040). Anterior and total corneal SA and RMS were significantly higher on the spasm side (p = 0.032, p = 0.005; p = 0.015, p = 0.006, respectively). TMH, TMD and TBUT were significantly lower in Group 1 (p = 0.01, p = 0.02 and p = 0.03, respectively). Schirmer I test values were similar between groups (p > 0.05). Conclusion In HFS patients, there are changes in corneal parameters and tear film in the eye on the spasm side compared to unaffected eye.