Lacrimal Gland Agenesis

Overview

Lacrimal gland agenesis is a rare condition in which the lacrimal gland, the gland that produces the watery part of tears, is missing or fails to develop properly before birth. It can affect one or both eyes. Because the gland is responsible for keeping the surface of the eye moist, its absence leads to a lack of tears (alacrima) and significant dry eye that is present from early life.

Without enough tears, the surface of the eye is not properly lubricated or protected, which can cause irritation and, over time, damage to the clear front window of the eye (the cornea). The condition is sometimes part of a broader syndrome affecting other glands. While the missing gland cannot be replaced, careful, lifelong eye care can keep the eyes comfortable and protect vision.

Symptoms

Symptoms reflect a long-standing lack of tears and usually begin in infancy or childhood.

• Dry, gritty, or burning eyes
• Few or no tears, even when crying
• Redness and frequent eye irritation
• Sensitivity to light
• Blurred or fluctuating vision
• Eye discomfort that worsens in wind, dry air, or with screen use
• Recurrent eye-surface problems or infections in more severe cases

In infants, a lack of tears when crying may be the first clue.

Causes

Lacrimal gland agenesis is caused by the tear gland failing to form normally during development before birth. The reason this happens is not fully understood and varies between individuals.

• Isolated developmental difference: The gland does not form, sometimes with no other associated condition.
• Part of a syndrome: In some cases it occurs alongside other features, such as differences in the salivary glands or tear-drainage structures, as part of a broader genetic or developmental syndrome.

It is present from birth and is not caused by injury, infection, or anything that happened after the baby was born.

Risk Factors

• A family history of related glandular or tear conditions, in some cases
• Being part of a syndrome that affects gland development

Because the condition is rare and present from birth, there are no lifestyle risk factors, and it often occurs without any identifiable family history.

Diagnosis

Diagnosis is made by an eye specialist who evaluates the dryness and looks for the absence of the gland:

• Eye examination: Checks the surface of the eye for dryness and damage.
• Tear testing: Measures of tear production confirm a very low or absent tear output.
• Imaging: MRI or CT scans can show that the lacrimal gland is missing or underdeveloped.
• Further evaluation: Assessment for related glandular or syndromic features when appropriate.

Treatment

The missing gland cannot be restored, so treatment focuses on keeping the eye surface moist and protected throughout life.

• Artificial tears and lubricants: Frequent use of preservative-free drops, gels, or ointments is the foundation of care.
• Conserving tears: Punctal plugs can block tear drainage so that the limited or supplemented moisture stays on the eye longer.
• Protecting the eyes: Moisture-chamber glasses, humidifiers, and avoiding dry, windy environments help.
• Treating complications: Prompt care for any corneal damage or infection.
• Specialty options: In severe cases, special contact lenses or other measures may be used under specialist guidance.

Regular follow-up with an eye specialist helps protect long-term vision.

Prevention

Lacrimal gland agenesis cannot be prevented, because the gland fails to form during development before birth for reasons that are not well understood. The most important steps are early diagnosis and consistent eye care: maintaining lubrication, protecting the eye surface, and attending regular eye exams so that any damage to the cornea is caught and treated early to preserve vision.

When to See a Doctor

See an eye doctor if you or your child has persistent dry, irritated eyes, especially with few or no tears when crying. Seek prompt care for worsening eye pain, marked light sensitivity, a sudden drop in vision, or a red eye with discharge, which can indicate damage or infection of the cornea that needs urgent treatment to protect sight.

Related Topics

Frequently Asked Questions

References

1. American Academy of Ophthalmology. Dry Eye and Tear Disorders.
2. MedlinePlus, U.S. National Library of Medicine. Dry eye.
3. National Eye Institute (NEI). Dry Eye.
4. Genetic and Rare Diseases Information Center (GARD), NIH. Alacrima.