Alacrima, a rare cause of pediatric dry eye

Area of Science:

• Ophthalmology
• Pediatric Medicine
• Genetics

Background:

• Severe photophobia and ocular pain in children can indicate underlying conditions like dry eye.
• Alacrima, the congenital absence of tears, is a rare disorder that may be overlooked in pediatric patients.
• Early diagnosis and management are crucial for preventing long-term ocular complications.

Observation:

• A 12-year-old boy presented with a 4-5 year history of severe bilateral photophobia and recent exacerbation of ocular pain.
• Parents reported a history of crying without tears since birth.
• Ocular examination revealed no systemic signs, and serology tests were negative.

Findings:

• Computerized tomography of the orbits demonstrated bilateral hypoplasia of the lacrimal glands.
• Clinico-radiological correlation confirmed the diagnosis of alacrima.
• The patient experienced symptomatic relief with artificial tears and permanent punctal occlusion via cautery.

Implications:

• Alacrima should be included in the differential diagnosis for severe pediatric dry eye.
• Prompt identification and treatment of alacrima can alleviate symptoms and prevent potential vision impairment.
• This case highlights the importance of considering rare conditions in pediatric ophthalmology.