Alacrima

Alacrima means the eyes do not make enough tears or, in some people, almost no tears at all. Tears are not only “water.” Healthy tears are a balanced mix of water, oil, and mucus with protective proteins and salts. They keep the eye surface smooth, wash away dust and germs, and feed the clear front window of the eye (the cornea). When tear production is very low or absent, the eye surface dries out, becomes irritated, and can get damaged. Vision can blur, and the eyes may hurt, burn, or feel gritty. Alacrima is most often part of “aqueous-deficient dry eye,” which means the watery layer from the lacrimal gland is too little. It can be present from birth (congenital) or appear later in life (acquired). Sometimes it occurs alone; sometimes it is one feature of a larger syndrome that also affects nerves, skin, mouth, or other organs.

Alacrima means little or no tear production. Tears keep the front of the eye smooth, clear, and protected. When the lacrimal (tear-making) glands do not make enough tears, the eye surface becomes dry. This can cause burning, grittiness, stinging, redness, sensitivity to light, blurred vision, and frequent eye infections. Alacrima can be present from birth (congenital), or it can develop later because of diseases, nerve problems, gland damage, medicines, or radiation. It may appear alone, or as part of a syndrome (for example, “triple-A” or Allgrove syndrome: Alacrima, Achalasia, Adrenal insufficiency). Alacrima is different from blocked tear drainage (which causes watery eyes). Here, the problem is not enough tear production.

Alacrima is different from evaporative dry eye, where tears are made but evaporate too fast (often from oil-gland problems). In alacrima, the main problem is low tear output, so the “tear lake” at the eyelid edge is small, and tests that measure tear flow are very low.

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Other Names

People and books may use different words for the same idea. These names often appear in medical notes or articles:

• Absence of tears or lack of tears – plain descriptions of the problem.

• Aqueous-deficient dry eye – dry eye caused by not enough watery tears.

• Hypolacrimation – reduced tear production.

• Adacrya (historical/rare) – an older word used to mean no tears.

• Lacrimal gland aplasia/agenesis – used when the tear gland did not develop; this is a cause and is sometimes used as a label.

• Reflex tearing failure – used when the reflex pathways that trigger tearing do not work.

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Types

You may see alacrima grouped in several simple ways:

1. By time of onset

   • Congenital alacrima: present from birth or early infancy. Often due to missing or underdeveloped lacrimal glands or nerve pathway problems and may be part of a syndrome.

   • Acquired alacrima: develops later due to autoimmune disease, scarring, nerve damage, drugs, radiation, surgery, or severe systemic illness.

2. By scope

   • Isolated alacrima: the tear problem occurs alone.

   • Syndromic alacrima: occurs with other problems (for example, swallowing trouble or adrenal problems in “Triple-A syndrome”).

3. By side and degree

   • Unilateral or bilateral: one eye or both eyes.

   • Complete or partial: almost no tears vs. very low tears.

4. By mechanism

   • Gland failure: the lacrimal gland is absent, damaged, inflamed, or infiltrated.

   • Neurogenic failure: the nerves that drive tear production or reflex tearing are damaged.

   • Obstructive/ductal failure: the ducts that deliver tears from the gland are malformed or blocked.

   • Systemic/hormonal/medication related: body-wide conditions or drugs suppress gland output.

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Causes

1. Congenital lacrimal gland agenesis or aplasia
   The tear glands did not develop before birth or are very small. Babies show little or no tearing even when crying. This directly causes alacrima because there is no normal gland tissue to make watery tears.

2. Triple-A (Allgrove) syndrome
   A rare genetic condition with Alacrima, Achalasia (swallowing tube problem), and Adrenal insufficiency. Nerve and gland dysfunction reduce tear output from infancy or childhood.

3. Lacrimo-auriculo-dento-digital (LADD) syndrome
   A genetic disorder affecting lacrimal (tear) and salivary glands, ears, teeth, and fingers. Tear glands and ducts may be underdeveloped, leading to very low tear production.

4. Familial dysautonomia (Riley–Day syndrome)
   A hereditary autonomic nerve disorder. The nerves that trigger reflex tearing do not work well, so the eyes stay dry even with irritation.

5. CIPA (congenital insensitivity to pain with anhidrosis)
   A genetic nerve disorder with loss of pain sensation and sweat production. Autonomic nerve damage can also reduce tear secretion.

6. Congenital cranial neuropathies (e.g., Möbius)
   When facial (VII) or trigeminal (V) nerve pathways are abnormal, lacrimal stimulation is weak, so reflex tearing fails, causing alacrima.

7. Sjögren syndrome
   An autoimmune disease where the immune system attacks moisture-producing glands, including lacrimal glands. Tear output falls over time and eyes become very dry and irritated.

8. Chronic graft-versus-host disease (after bone marrow transplant)
   Donor immune cells attack the patient’s glands and ocular surface. Tear glands scar and shrink, causing severe aqueous deficiency.

9. Sarcoidosis
   Immune granulomas can infiltrate the lacrimal glands. The gland becomes firm and produces fewer tears.

10. Amyloidosis
    Abnormal protein deposits infiltrate tissues, including the lacrimal gland, reducing its function and leading to low tears.

11. Radiation injury to the orbit or head/neck
    Radiation therapy for cancers near the eye or salivary glands can scar and atrophy the lacrimal gland, leading to permanent alacrima.

12. Surgery or trauma to the lacrimal gland or its ducts
    Accidental or planned removal/injury to the gland or its ducts (e.g., tumor surgery) can permanently reduce or stop tear production.

13. Severe cicatrizing conjunctivitis (Stevens–Johnson syndrome/TEN)
    Intense scarring of the ocular surface and lids disrupts glands and ducts. The eye loses normal tear production and distribution.

14. Ocular cicatricial pemphigoid
    A chronic autoimmune scarring disease of the conjunctiva. Scarring damages accessory tear glands and goblet cells, lowering tears and mucin.

15. Medication effects (anticholinergics, antihistamines, some antidepressants, beta-blockers, isotretinoin)
    These drugs reduce gland stimulation or modify oil/mucin layers. Output of watery tears falls, sometimes sharply.

16. Botulinum toxin to the lacrimal gland
    Used deliberately to reduce watering in some diseases. If dose spreads or is repeated, it can temporarily create alacrima.

17. Diabetes with autonomic neuropathy
    Long-standing diabetes can damage autonomic nerves that drive tear secretion, giving low reflex tearing and dry eye.

18. Trigeminal nerve damage
    The cornea’s sensory nerve (V1) is part of the tearing reflex loop. If sensation is lost, the brain does not trigger tears, causing “neurotrophic” dryness and alacrima.

19. Vitamin A deficiency and severe malnutrition/dehydration
    Vitamin A keeps the ocular surface healthy and supports tear-related cells. Deficiency and severe dehydration reduce tear quality and quantity.

20. Aging and hormonal changes (e.g., menopause, low androgens)
    With age, lacrimal glands shrink and hormones that support them decline. The result is chronically low tear output in many older adults.

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Symptoms

1. Dryness and grittiness – the eye feels sandy or dusty because the smooth tear layer is missing.

2. Burning or stinging – exposed nerve endings on a dry cornea cause a burning sensation.

3. Foreign-body feeling – it feels like something is in the eye, even when it is clean.

4. Redness – irritated surface blood vessels dilate, making the eye look red.

5. Blurred or fluctuating vision – vision goes in and out of focus because the tear film is patchy.

6. Light sensitivity (photophobia) – a dry, rough cornea becomes sensitive to light.

7. Stringy or sticky mucus – the balance of tear components is off, so mucus becomes more obvious.

8. Eye fatigue – reading and screen work become tiring because the dry surface needs constant blinking.

9. Pain or soreness – dryness can inflame the surface and eyelid margins.

10. Trouble opening eyes in the morning – lids may stick to the dry surface overnight.

11. Reflex watering at times – paradoxically, severe irritation can trigger brief overflow from remaining glands, but it does not last or fully wet the eye.

12. Contact lens intolerance – lenses feel uncomfortable or drop out because lubrication is poor.

13. Recurrent erosions or abrasions – the surface can break down, causing sudden sharp pain.

14. More infections or inflammation (blepharitis/conjunctivitis) – the protective cleaning action of tears is reduced.

15. Difficulty in windy, smoky, or air-conditioned places – low humidity worsens symptoms quickly.

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Diagnostic Tests

(Grouped so it is easier to follow. Your doctor will not need every test. They choose based on your story and exam.)

Physical Examination

1. External inspection and tear meniscus check
   The doctor looks at the tear lake along the lower lid. In alacrima, this strip is tiny or absent. The skin and lids are also checked for redness, crusts, or scarring.

2. Blink rate and completeness observation
   Incomplete or infrequent blinks leave the eye exposed. The clinician watches how often and how fully you blink because this affects tear spread and can mimic worse dryness.

3. Eyelid margin and lash evaluation
   The lid edges and oil glands are examined for inflammation or scarring. While mainly related to evaporative dryness, lid disease can worsen symptoms in people with alacrima.

4. Slit-lamp biomicroscopy of the ocular surface
   A microscope with bright light shows subtle surface roughness, filaments, mucus strands, and signs of chronic dryness. It also helps guide where to place dyes for later tests.

Manual / Clinical Chairside Tests

5. Schirmer I test (without anesthesia)
   A small paper strip hangs from the lower lid for 5 minutes. Wetting below about 5 mm suggests severe aqueous deficiency typical of alacrima.

6. Schirmer II (nasal stimulation) or reflex Schirmer
   Gentle nasal stimulation triggers reflex tearing. If wetting stays very low, reflex pathways or the gland are failing, supporting alacrima.

7. Basic Secretion Test (with anesthesia)
   Numbing drops are used so reflex tearing stops. The remaining wetting reflects basal tear output. Very low values indicate poor gland function.

8. Phenol Red Thread test
   A thin red thread is placed briefly in the lower lid. It measures tear quantity in less time than Schirmer. Low values support alacrima.

9. Tear Break-Up Time (TBUT)
   A small amount of fluorescein dye is placed in the eye. The doctor measures how fast the tear film breaks into dry spots. Very short times show an unstable tear film, which often accompanies low tear volume.

10. Fluorescein corneal staining
    The dye highlights surface damage as tiny green dots or larger patches. More staining means more dryness and risk to the cornea.

11. Lissamine green (or rose bengal) conjunctival staining
    This dye shows damaged or unprotected cells on the white of the eye and eyelid margins, common when tears are insufficient.

Laboratory / Pathology-Oriented Tests

12. Tear osmolarity
    A tiny sample of tears is measured for saltiness. High osmolarity indicates concentrated, unhealthy tears typical of aqueous deficiency.

13. Tear protein tests (lactoferrin or lysozyme)
    Protective proteins fall when the lacrimal gland is failing. Low levels point toward alacrima rather than pure evaporative disease.

14. Autoimmune blood panel (ANA, RF, anti-SSA/Ro, anti-SSB/La)
    These tests look for Sjögren syndrome or related autoimmune causes. A positive result supports an immune-mediated reason for alacrima.

15. Conjunctival impression cytology
    A gentle filter paper touches the eye surface to collect cells. Under a microscope, loss of goblet cells and surface changes confirm chronic dryness and help grade severity.

16. Minor salivary gland (lip) biopsy when indicated
    If Sjögren is suspected, a tiny lip biopsy can show immune cells attacking the gland. A positive biopsy strengthens the diagnosis of an autoimmune cause.

Electrodiagnostic / Autonomic Tests

17. Quantitative Sudomotor Axon Reflex Test (QSART) or sympathetic skin response
    These assess autonomic nerve function in the skin. Abnormal results suggest a wider autonomic neuropathy that may also impair reflex tearing.

18. Blink reflex study (trigeminal–facial EMG)
    Electrical stimulation and surface electrodes test the trigeminal and facial nerve loop. Abnormalities point to neurogenic failure of reflex tearing.

Imaging Tests

19. Orbital MRI or CT focused on the lacrimal glands
    Imaging checks if the glands are absent (congenital), small, inflamed, infiltrated (sarcoid, amyloid), or scarred from radiation or surgery.

20. Dacryoscintigraphy (tear gland secretion and flow study)
    A tiny tracer shows how tears are produced and travel. Poor tracer entry from the lacrimal gland supports low secretion as the main problem in alacrima.

Non-pharmacological Treatments (therapies & others)

(Each item includes a short description, purpose, and mechanism.)

1. Blink training and screen breaks
   Description: Practice full, gentle blinks and follow the 20-20-20 rule (every 20 minutes, look 20 feet away for 20 seconds).
   Purpose: Reduce evaporative stress.
   Mechanism: Complete blinks spread the tear film evenly and refresh oil and water layers, slowing evaporation.

2. Environmental control
   Description: Use a humidifier, avoid direct fans/air-conditioning, protect from wind.
   Purpose: Keep moisture around eyes.
   Mechanism: Higher air humidity and less airflow reduce tear evaporation.

3. Moisture chamber glasses/goggles
   Description: Wraparound glasses with a soft seal.
   Purpose: Shield the ocular surface.
   Mechanism: Traps humidity around the eye, reducing evaporative loss.

4. Warm compresses
   Description: Clean, warm (not hot) compress for 5–10 minutes twice daily.
   Purpose: Support oil glands in eyelids (meibomian glands).
   Mechanism: Heat softens meibum, improving oil layer quality and stabilizing tears.

5. Eyelid hygiene
   Description: Gentle lid scrubs or commercial wipes.
   Purpose: Reduce debris/bacteria at lid margins.
   Mechanism: Cleaner lids improve meibomian gland function and tear stability.

6. Hydration and regular blinking while reading
   Description: Drink water; set reminders to blink during sustained tasks.
   Purpose: Support tear volume and distribution.
   Mechanism: Systemic hydration and frequent blinks help maintain the tear film.

7. Cold compress for burning episodes
   Description: Short, clean cold compresses.
   Purpose: Calm surface inflammation.
   Mechanism: Vasoconstriction and reduced nerve activity ease discomfort.

8. Allergen avoidance
   Description: Reduce exposure to dust, smoke, and irritants.
   Purpose: Lower eye irritation and inflammation.
   Mechanism: Fewer triggers → less inflammatory damage to tear surface.

9. Smoking cessation / smoke avoidance
   Description: Avoid active and passive smoke.
   Purpose: Protect tear film and eye surface.
   Mechanism: Smoke toxins destabilize oil and water layers; removing them reduces evaporation and irritation.

10. Nighttime eye shielding
    Description: Sleep mask or moisture shield.
    Purpose: Prevent overnight drying and exposure.
    Mechanism: Physical barrier keeps humidity higher against the eye.

11. Eyelid taping for nocturnal lagophthalmos (if lids don’t fully close)
    Description: Gentle medical tape to help lids close at night.
    Purpose: Keep cornea covered.
    Mechanism: Reduces exposure-related drying.

12. Scleral lenses / PROSE devices (fitted by specialists)
    Description: Large rigid lenses that vault the cornea and hold fluid.
    Purpose: Continuous fluid reservoir over the eye.
    Mechanism: Creates a stable, protective fluid bath to replace missing tears.

13. Treating eyelid malposition
    Description: Evaluate for entropion/ectropion (in-turning/out-turning lids).
    Purpose: Ensure proper lid-globe contact and blink.
    Mechanism: Good eyelid position spreads tear film effectively.

14. Cool, preservative-free artificial tear “washouts”
    Description: Rinse eyes with single-use, preservative-free saline/tears.
    Purpose: Remove irritants and re-wet quickly.
    Mechanism: Mechanical flushing and lubrication.

15. Contact lens holiday (if lenses irritate)
    Description: Pause contact lens wear when symptomatic.
    Purpose: Let surface heal.
    Mechanism: Reduces mechanical friction and hypoxia.

16. Task and workstation changes
    Description: Adjust screen height, reduce glare, increase font size.
    Purpose: Encourage natural blinking and comfort.
    Mechanism: Less strain → more blinks and better tear stability.

17. UV-blocking eyewear outdoors
    Description: Sunglasses with UV protection.
    Purpose: Lower photic and wind stress.
    Mechanism: Reduces oxidative stress and evaporation.

18. Treat associated nasal/sinus dryness
    Description: Saline sprays; manage allergies.
    Purpose: Calm mucosal inflammation that can affect eyes.
    Mechanism: Shared mucosal immune environment becomes less inflamed.

19. Behavioral pain coping and stress management
    Description: Breathing exercises, CBT-style coping for chronic discomfort.
    Purpose: Improve symptom tolerance.
    Mechanism: Modulates central pain processing and reduces sympathetic drive.

20. Education and trigger diary
    Description: Track activities, environments, and symptoms.
    Purpose: Personalize avoidance and routines.
    Mechanism: Identifies personal triggers (e.g., AC, long screen time) to control them.

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Drug Treatments

1. Preservative-free artificial tears (carboxymethylcellulose, hypromellose, hydroxypropyl methylcellulose, PVA) – Lubricant
   Dosage/Time: 1–2 drops per eye, up to 4–8×/day; more often if unit-dose, preservative-free.
   Purpose/Mechanism: Adds water/bulk to tear film; reduces friction; dilutes inflammatory mediators.
   Side effects: Temporary blur, rare allergy.

2. Gel drops (carbomer, HP-guar systems)
   Dosage/Time: 1 drop 2–6×/day or as needed.
   Purpose/Mechanism: Thicker formulations stay longer on the eye.
   Side effects: Temporary blur.

3. Night ointments (petrolatum/mineral oil)
   Dosage/Time: 0.5–1 cm ribbon at bedtime.
   Purpose/Mechanism: Occlusive layer to prevent overnight drying.
   Side effects: Morning blur, sticky lids.

4. Hyaluronic acid (0.1–0.3%)
   Dosage/Time: 1 drop 3–6×/day.
   Purpose/Mechanism: Strong water-binding polymer; promotes epithelial healing.
   Side effects: Rare irritation.

5. Trehalose eye drops
   Dosage/Time: 1 drop 3–6×/day.
   Purpose/Mechanism: Protects cells from desiccation stress; stabilizes membranes.
   Side effects: Mild stinging possible.

6. Cyclosporine A 0.05–0.1% (topical immunomodulator)
   Dosage/Time: 1 drop twice daily; effect builds over 1–3 months.
   Purpose/Mechanism: Lowers T-cell–mediated inflammation in lacrimal unit; improves natural tear production.
   Side effects: Burning on instillation, rare infection risk.

7. Lifitegrast 5% (LFA-1 antagonist)
   Dosage/Time: 1 drop twice daily; benefit in weeks.
   Purpose/Mechanism: Blocks inflammatory cell adhesion; reduces ocular surface inflammation.
   Side effects: Dysgeusia (odd taste), irritation.

8. Short course topical corticosteroids (e.g., loteprednol 0.2–0.5%)
   Dosage/Time: 1 drop 2–4×/day for 1–2 weeks; taper under supervision.
   Purpose/Mechanism: Rapid anti-inflammatory effect to break flares.
   Side effects: Pressure rise, cataract risk with prolonged use—needs monitoring.

9. Topical azithromycin (for MGD-associated instability)
   Dosage/Time: Per product guidance (often 1–2×/day, short course).
   Purpose/Mechanism: Anti-inflammatory and improves meibomian secretions.
   Side effects: Irritation.

10. Oral doxycycline (sub-antimicrobial dosing, e.g., 20–50 mg once–twice daily)
    Time: Weeks to months (MD-guided).
    Purpose/Mechanism: Anti-inflammatory; alters meibum; inhibits matrix metalloproteinases.
    Side effects: GI upset, sun sensitivity; avoid in pregnancy/children.

11. Oral azithromycin (pulsed, clinician-directed)
    Purpose/Mechanism: Anti-inflammatory benefits for MGD and lid disease.
    Side effects: GI upset, rare cardiac QT effects—physician oversight essential.

12. Cholinergic secretagogues (pilocarpine 5 mg PO TID; cevimeline 30 mg PO TID)
    Time: Ongoing if tolerated (often for Sjögren-related dryness).
    Purpose/Mechanism: Stimulate exocrine glands to increase tear/saliva.
    Side effects: Sweating, flushing, GI cramps; caution in asthma, heart disease.

13. Topical secretagogues (where available: diquafosol 3%, rebamipide 2%)
    Dosage/Time: Typically QID to Q6/day (per local labeling).
    Purpose/Mechanism: Stimulate mucin and water secretion to stabilize tear film.
    Side effects: Mild irritation.

14. Autologous serum eye drops (20–100%)
    Dosage/Time: Often 6–8×/day; prepared from patient’s blood.
    Purpose/Mechanism: Provides growth factors, vitamins, and anti-inflammatory proteins that mimic natural tears.
    Side effects: Logistics; contamination risk minimized with sterile prep.

15. Platelet-rich plasma (PRP) eye drops
    Dosage/Time: Similar to serum; protocol-based.
    Purpose/Mechanism: High platelet growth factors support corneal healing.
    Side effects: As above.

16. N-acetylcysteine 5–10% (topical, for filaments/mucus)
    Dosage/Time: 3–4×/day short course.
    Purpose/Mechanism: Mucolytic; breaks mucus filaments and reduces irritation.
    Side effects: Stinging.

17. Topical vitamin A (retinol palmitate) where available
    Dosage/Time: Per product guidance.
    Purpose/Mechanism: Supports goblet cell/mucin health.
    Side effects: Rare irritation.

18. Topical omega-3/glycerol-based lubricants
    Dosage/Time: As needed.
    Purpose/Mechanism: Improves lipid layer, slows evaporation.
    Side effects: Mild blur.

19. Punctal plug placement (collagen/silicone) – procedure with drug-like goal
    Time: Collagen temporary (weeks); silicone long-term.
    Purpose/Mechanism: Conserves tears by blocking outflow.
    Side effects: Foreign body sensation, rare infection/extrusion. (Also listed under surgeries.)

20. Systemic disease–specific therapy (examples)

• Adrenal insufficiency (in Allgrove): Hydrocortisone/fludrocortisone per endocrinology.

• Autoimmune disease (e.g., Sjögren, IgG4-RD): Rheumatology-guided immunomodulators.
  Purpose/Mechanism: Treat the root cause to improve lacrimal function.
  Side effects: Drug-specific; require medical supervision.

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Dietary Molecular Supplements

(Discuss with your clinician; quality varies. Show typical doses when known.)

1. Omega-3 fatty acids (EPA/DHA)
   Dose: ~1,000–2,000 mg/day combined EPA+DHA.
   Function/Mechanism: Anti-inflammatory; improves meibum quality and tear stability.

2. Flaxseed oil (ALA)
   Dose: ~1–2 tablespoons/day (or capsules per label).
   Function: Plant omega-3 precursor; supports lipid layer.

3. Vitamin D
   Dose: Commonly 1,000–2,000 IU/day (personalized by labs).
   Function: Immune modulation; low levels link to worse dry eye.

4. Vitamin A (systemic only if deficient)
   Dose: Per clinician; avoid overdose.
   Function: Epithelial and goblet cell health.

5. Vitamin C
   Dose: 250–500 mg/day.
   Function: Antioxidant support for ocular surface healing.

6. Curcumin (with piperine for absorption)
   Dose: 500–1,000 mg/day (standardized extracts).
   Function: Anti-inflammatory pathways (NF-κB).

7. Gammalinolenic acid (borage/evening primrose oil)
   Dose: 240–480 mg GLA/day.
   Function: Anti-inflammatory eicosanoid balance; dry eye symptom relief in some studies.

8. Zinc (if deficient)
   Dose: 10–20 mg/day short term.
   Function: Epithelial repair and immune function.

9. Coenzyme Q10
   Dose: 100–200 mg/day.
   Function: Mitochondrial and antioxidant support for stressed tissues.

10. N-acetylcysteine (oral)
    Dose: 600–1,200 mg/day.
    Function: Mucolytic and antioxidant; may reduce mucus filaments and oxidative stress.

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Hard Immunity Booster / Regenerative / Stem-cell-type” Therapies

(Evidence and availability vary; specialist care required.)

1. Autologous serum eye drops
   Dose: 20–100%, 6–8×/day per protocol.
   Function/Mechanism: Growth factors (EGF, vitamin A, albumin) mimic natural tears; promote epithelial regeneration.

2. Platelet-rich plasma (PRP) eye drops
   Dose: Per center protocol.
   Function: Platelet-derived growth factors accelerate surface healing.

3. Umbilical cord serum drops (where available)
   Dose: Protocol-based.
   Function: Rich growth factor mixture for severe ocular surface disease.

4. Amniotic membrane therapy (in-office or surgical placement)
   Dose: Single placement; dissolvable or sutured.
   Function: Provides anti-inflammatory, anti-scarring matrix and growth factors for healing.

5. Recombinant human nerve growth factor (cenegermin) – select cases
   Dose: As labeled when indicated (neurotrophic keratitis).
   Function: Regenerates corneal nerves, may improve sensation and healing where neuropathy contributes.

6. Limbal stem cell transplantation (for severe ocular surface failure)
   Dose: Surgical grafting (autologous/allogeneic).
   Function: Rebuilds corneal epithelial stem cell population when severely deficient.

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Surgeries / Procedures

(Chosen for severe or refractory cases.)

1. Punctal plugs (temporary collagen or permanent silicone)
   Procedure: Insert small plug into tear drainage opening.
   Why: Keep tears on the eye longer by blocking drainage.

2. Thermal punctal cautery (permanent closure)
   Procedure: Heat seals the punctum/canaliculus.
   Why: For patients who expel plugs or need stronger tear conservation.

3. Tarsorrhaphy (partial eyelid closure)
   Procedure: Temporarily or permanently sew outer eyelids partially together.
   Why: Reduce exposure and evaporation in severe dryness or poor blink/closure.

4. Amniotic membrane transplantation
   Procedure: Place biologic membrane on cornea/conjunctiva.
   Why: Speed healing, reduce inflammation, protect surface in severe disease.

5. Minor salivary gland transplantation to eyelids/fornix (specialized centers)
   Procedure: Transplant patient’s lip salivary glands to eyelid area to secrete fluid onto eye.
   Why: Provide a tear substitute in extreme, end-stage dryness when other methods fail.

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Preventions

1. Keep indoor humidity moderate (humidifier) and avoid direct air on the face.

2. Blink fully and often, especially on screens; follow 20-20-20.

3. Wear wraparound/UV-blocking glasses outdoors.

4. Stay well hydrated; limit alcohol binges which dehydrate.

5. Avoid smoke and dusty, windy places when possible.

6. Use preservative-free drops if you need frequent dosing.

7. Review medicines with your doctor (anticholinergics, some antidepressants, isotretinoin, antihistamines can worsen dryness).

8. Manage lid margin disease with regular warm compresses and lid hygiene.

9. Treat allergies and sinus problems to reduce inflammation spillover.

10. Seek regular eye checks if you have autoimmune disease, diabetes, thyroid disease, or are on glaucoma drops with preservatives.

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When to See a Doctor

• Right away (urgent): sudden vision loss, severe eye pain, marked light sensitivity, a corneal “white spot,” trauma or chemical exposure, or contact lens wear with severe redness/pain.

• Soon (days): persistent burning/grittiness, blurred vision, redness, frequent mucus/filaments, or if symptoms limit daily work/screen use.

• Screening: if a child never produces tears while crying, or you have dry mouth, joint pain, fatigue, rashes, swelling of glands, trouble swallowing (achalasia), dizziness on standing, or unexplained salt cravings/weight loss—these may suggest a systemic condition linked to alacrima (e.g., Sjögren syndrome, Allgrove syndrome, adrenal problems).

• Medication review: if symptoms began after new medicines (e.g., antihistamines, isotretinoin, anticholinergics, some antidepressants/anxiolytics).

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What to Eat and What to Avoid

What to eat:

1. Fatty fish (salmon, sardines, mackerel) 2–3×/week for omega-3s.

2. Nuts and seeds (walnut, chia, flax).

3. Colorful fruits/vegetables rich in antioxidants (berries, leafy greens, carrots).

4. Whole grains and legumes for steady nutrients.

5. Adequate water throughout the day.

What to limit/avoid:

1.  Heavy alcohol (dehydrates and inflames).
2. Smoking and smoky foods/environments.
3.  Ultra-processed, very salty snacks that can dehydrate.
4. Very spicy foods if they trigger eye rubbing or redness for you.
5. Excess caffeinated energy drinks (mild coffee/tea may be fine for many—individualize).

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Frequently Asked Questions

1) Is alacrima the same as dry eye?
Not exactly. Alacrima is severe lack of tear production. Dry eye can be from poor tear quality or evaporation too. Many people with alacrima also have dry eye symptoms.

2) Can children be born with alacrima?
Yes. Some babies/children have congenital alacrima due to under-developed lacrimal glands or genetic syndromes. If a child does not cry tears, see a specialist.

3) Which tests confirm alacrima?
Common tests include Schirmer’s (paper strip tear volume), phenol red thread, tear breakup time, ocular surface staining (fluorescein, lissamine green), tear osmolarity, MMP-9, eyelid/meibomian evaluation, and when indicated imaging (ultrasound/MRI of lacrimal glands) and blood tests for autoimmune disease (e.g., SSA/SSB).

4) Will artificial tears cure alacrima?
They relieve symptoms and protect the eye, but they do not fix the gland that is not making tears. They are still very helpful.

5) Are preservative-free drops better?
If you use drops more than 4 times daily or have sensitive eyes, preservative-free is often better because preservatives can irritate the surface.

6) How long until cyclosporine or lifitegrast works?
They often need 4–12 weeks to show full benefit. Keep using as prescribed unless your doctor advises otherwise.

7) What if nothing helps?
Advanced options include autologous serum or PRP drops, amniotic membrane, scleral lenses, punctal cautery, or salivary gland transplantation—usually in specialist centers.

8) Can alacrima be part of a bigger disease?
Yes. It can occur with Sjögren syndrome, IgG4-related disease, sarcoidosis, familial dysautonomia, ectodermal dysplasias, Allgrove (AAA) syndrome, nerve injuries, and others.

9) Are contact lenses safe in alacrima?
Soft lenses may worsen dryness. Scleral lenses can be very helpful because they hold fluid over the eye; they require specialist fitting.

10) Can surgery stop the dryness?
Surgery cannot make new tears, but punctal closure and tarsorrhaphy can conserve moisture, and salivary gland transplant can provide a tear substitute in extreme cases.

11) Do omega-3 supplements work?
Some people report symptom relief, especially with meibomian gland problems. Quality and dose matter, and results vary.

12) Is screen time really that bad?
Long, focused screen use reduces blink rate. Fewer blinks → faster evaporation. Frequent breaks and conscious blinking help.

13) Are steroid drops safe?
Short courses can calm flares, but long use can raise eye pressure and risk cataract. They must be supervised by an eye doctor.

14) What are the biggest daily mistakes?
Fans/AC blowing on the face, forgetting to blink on screens, using preserved drops very frequently, and ignoring lid hygiene.

15) Will I have alacrima forever?
If due to gland under-development or permanent damage, the condition tends to persist. Many people control symptoms well with layered care and regular follow-up.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: September 11, 2025.