Which of the following is NOT considered a secondary lacrimal gland deficiency that can cause aqueous deficient dry eye?

• A. Aging leads to ductal stenosis
• B. LASIK surgery damaging CN V1
• C. Trachoma leads to obstruction of lacrimal gland ducts
• D. Inflammatory infiltration of lacrimal gland due to sarcoidosis

Answer: (A)

Aqueous-deficient dry eye stems from reduced tear production by the lacrimal gland or a loss of its neural stimulation, not from problems that prevent tears from reaching the surface. The key idea is distinguishing gland function from tear drainage or routing.

Aging with ductal stenosis is not a true loss of lacrimal gland secretion. It’s a narrowing of the ducts, which can impede tear delivery to the ocular surface, but the gland’s production isn’t directly diminished. So it’s not considered a lacrimal gland deficiency causing decreased aqueous production.

The other scenarios involve the gland or its control directly:

• damaging corneal nerves from LASIK reduces reflex tear stimulation to the lacrimal gland, lowering tear production.

• trachoma can scar and obstruct lacrimal gland ducts, diminishing tear flow into the eye.

• inflammatory infiltration of the lacrimal gland (as in sarcoidosis) reduces gland function and tear production.

So the option describing aging-related ductal stenosis is the one that does not represent a secondary lacrimal gland deficiency causing aqueous-deficient dry eye.