|“My baby doesn’t cry.”|
|Absent reflex tears|
|Dry eyes (alacrima)|
|• Associated with other systemic diseases|
|Absent reflex tears|
|Baby doesn’t make tears when crying|
|Otherwise completely normal|
|Glassy appearance to eyes|
|Increased light sensitivity|
patients with dry eyes have symptoms of excess tearing (see text)|
|Absent reflex tearing|
|Eyes otherwise appear normal|
|Cornea and conjunctiva crisp and clear|
|Normal tear lakes|
|Possible visible corneal scars|
|Other systemic abnormalities|
|Sometimes excess tearing|
If there are no other symptoms are present and the examination
is otherwise normal (including a clear cornea), reassurance is usually
all that is necessary.
If the patient has symptoms of ocular irritation and photophobia,
referral is indicated.
Riley-Day syndrome (familial dysautonomia) causes markedly decreased
tear production, which increases the risk of vision loss due to
corneal scarring and infection. Early treatment with aggressive
lubrication is indicated.
In children, underproduction of tears is much less common than
excess tearing. There are 2 types of tears. Basal
tears are continuously secreted. They are necessary to keep
the eye lubricated and healthy. Reflex tears occur
in response to either external or emotional stimulation, such as
increased tearing in a brisk wind or crying when upset. They are
not necessary for ocular health.
- 1. Decreased reflex tears.
This is much more common than true dry eyes. These children have
normal basal tears (Figure 8–1) and their eyes are otherwise
- 2. Dry eyes. Dry eyes occur frequently
in adults as part of the aging process. They are less common in
infants and children. Patients with dry eyes have decreased or unstable
basal tear layers. This usually results in chronic ocular irritation.
This may be an isolated finding, or it may occur in association with
other systemic problems (Table 8–1). Paradoxically,
some patients with dry eyes may have symptoms of excess tearing (Figure 8–2). This occurs because the decreased basal tears predispose
the patient to ocular irritation. If the patients have normal reflex
tears, they will produce a bolus of tears in response to the irritation,
often enough to overflow and produce epiphora. As this bolus wears
off, the irritation recurs, and the patients go through a repetitive
cycle of decreased tears, irritation, and excess tears.
Normal tear lake. This is most easily visualized with
a penlight as a thin layer of fluid between the lower eyelid and
the eyeball (arrow). Note that the cornea is clear and the corneal
light reflex (long arrow) is crisp.
Table 8–1. Systemic