Lacrimal Disorders (Dry Eye Syndrome)



  • Diseases and abnormalities of tear production and maintenance of tear film
  • The most common lacrimal disorder is dry eye syndrome, which is often referred to as dysfunctional tear syndrome.
  • Lacrimal duct disorders usually result in overflow tearing.
  • System(s) affected: skin/exocrine


Very common throughout the United States; more often seen in arid climates:

  • Predominant gender: female > male
  • Predominant age: Dry eye symptoms increase with age and are most often seen in the elderly.

Etiology and Pathophysiology

  • Tear film is composed of three layers:
    • Mucin layer: allows spread of aqueous tears
    • Thick aqueous layer: produced by lacrimal gland
    • Lipid layer: controls tear evaporation
  • Results from poor tear production, rapid tear evaporation, and/or an abnormal concentration of mucin or lipid in tear film
  • Most common cause of dry eye symptoms is aqueous tear deficiency.
  • Decreased androgens are thought to contribute to a decrease in tear production.

Risk Factors

  • Exposure to dry environments (e.g., high altitudes)
  • Contact lenses wear
  • Female gender
  • Computer use
  • Hormonal diseases
  • History of collagen vascular disease such as rheumatoid arthritis, Sjögren syndrome, thyroid disease, rosacea, Bell palsy, eyelid abnormalities
  • Medications, including oral contraceptives, diuretics, β-blockers, anticholinergics, antihistamines, and antidepressants
  • Smoking
  • Vitamin A deficiency
  • Eye surgery: blepharoplasty, cataract, laser vision correction
  • Use of artificial tears (with preservatives)

General Prevention

  • Prevent exposure to eye irritants from pollution, cigarette smoke, and sun exposure.
  • Ensure adequate vitamin A intake through diet or as a supplement.
  • Patients with prior laser vision correction should wait at least 6 months before undergoing blepharoplasty because of the effects on corneal sensation, tear production, and tear film alteration.
  • Increasing awareness of this condition among people residing in dry environments
  • Decrease or stop contact lens wear.

Commonly Associated Conditions

  • Sjögren syndrome
  • Rheumatoid arthritis
  • Thyroid disease
  • Rosacea
  • Pregnancy
  • Menopause
  • Malnutrition

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