Tearlessness occurs when the lacrimal glands are not developed congenitally, or due to an acquired autoimmune system disorder that disrupts lacrimal secretion, resulting in the desire to cry without tears. Tearlessness is an eye disease that cannot be cured, and patients can only rely on medicated ointments to improve symptoms or use special moisturizing glasses to avoid water evaporation. Differential diagnosis of underdeveloped lacrimal glands: 1, congenital lack of tears: seen in Riley-Day syndrome (familial autonomic abnormalities), manifested as tearlessness, corneal perceptual deficits fall in line with the nerve paralysis keratitis, although the patient may initially be asymptomatic, but will eventually develop into a typical sensory keratoconjunctival fever. 2, Acquired tearlessness: can be due to auditory neuroma or cerebellar pontine foot surgery destroying the lacrimal secretory nerve. Tumors or inflammation of the lacrimal gland itself can also reduce the production of tears. 3, tear film disappearance: tear film disappearance is one of the clinical manifestations of sjogren’s syndrome. Autoimmune conjunctivitis can cause damage to the epithelium of the eye surface and decreased stability of the tear film, leading to the development of ocular surface tear disease, which can seriously affect vision. The main diseases are sjogren’s syndrome (SS), conjunctival aspergillosis, and Stevens-Johnson syndrome.