Alacrima

Alacrima is a medical condition characterized by decreased or absent tear production from the lacrimal glands, resulting in insufficient tear film and dry eyes. It can be congenital or acquired. Congenital alacrima is rare and may occur as an isolated defect or as part of systemic disorders, most notably familial dysautonomia (Riley-Day syndrome), a hereditary autonomic neuropathy. It can also appear in ectodermal dysplasia syndromes such as AEC (ankyloblepharon-ectodermal defects) and related conditions. Acquired causes include autoimmune lacrimal gland disease (eg, Sjögren's syndrome), medications with anti-cholinergic effects, and obstruction or damage to the lacrimal glands.

Patients commonly experience dry, irritated eyes, grittiness, burning, photophobia, and mucous discharge. In infants, alacrima may present with persistent ocular surface symptoms and corneal exposure; the lack of tearing can be noted when reacting to irritants or pain.

Diagnosis is made by testing tear production, most commonly the Schirmer test, which measures tear wetting of a paper strip over five minutes. Low values indicate deficient tear production. Additional tests include tear break-up time, ocular surface staining with fluorescein, and evaluation for associated systemic disease. Imaging or evaluation of lacrimal glands may help identify gland agenesis or hypoplasia in rare congenital cases.

Management focuses on protecting and hydrating the ocular surface and treating underlying conditions. This includes preservative-free artificial tears or ointments, lacrimal punctal occlusion in selected cases, moisture goggles, humidification, and treatment of underlying autoimmune or genetic conditions where possible. Regular ophthalmologic follow-up is recommended to monitor for keratopathy.

Prognosis varies with the underlying cause; isolated congenital alacrima often has good prognosis with adequate tear supplementation, whereas syndromic alacrima can reflect broader autonomic or ectodermal disease requiring multidisciplinary care.