Scanning Tunneling Microscopy (STM) studies and Density Functional Theory (DFT) investigations of the interaction of water with the rutile TiO2 (110) surface are summarized. From high-resolution STM the following reactions have been revealed: water adsorption and diffusion in the Ti troughs, water dissociation in bridging oxygen vacancies, assembly of adsorbed water monomers into rapidly diffusing water dimers, and formation of water dimers by reduction of oxygen molecules. The STM results are rationalized based on DFT calculations, revealing the bonding geometries and reaction pathways of the water species on the TiO2 (110) surface.