It is not a single disease, but a group of diseases caused by several different causes, characterized by dry eyes and few tears. Clinical manifestations Keratoconjunctivitis of the lid fissure. This disease has a shortened tear film rupture time and can lead to filiform keratitis, keratoconjunctival dryness, which is manifested by a decrease in tears at the lid margin. It can also occur in many autoimmune diseases, and systemic diseases such as sarcoidosis and Waldenstroms macroglobulinemia. Treatment is replacement with artificial tears, and in severe cases protective goggles or obstruction of the tear dots.