1. Absence of blinking
2. Drugs, including the following:
 

acebutolol (?) amiodarone atenolol (?) betaxolol busulfan chlorambucil clonidine (?) cyclophosphamide doxepin ibuprofen

ketoprofen labetalol (?) levobunolol methyldopa metoprolol (?) nadolol (?) naproxen (?) oxprenolol (?) perhexiline pindolol (?)

practolol primidone propanolol (?) propoxyphene quinidine sulindac thiabendazole timolol vinblastine (?)

3. Following cicatricial conjunctivitis (see p. 194)
4. Illness or coma
*5. Lack of closure of lids in sleep
6. Result of exposure of conjunctiva to air

 A. Deficient closure of lids, such as with paralysis of orbicularis, as part of facial  palsy, spasms of the levator, or ectropion
 B. Excessive proptosis, such as in exophthalmic goiter or orbital tumor

*7. Vitamin A deficiency

 A. Dietary deficiencies, including malnutrition, cystic fibrosis, anorexia nervosa,  and bulimia
 B. Digestive tract disorders
  (1) Colitis and enteritis
  *(2) In pancreas-chronic pancreatitis
  (3) In stomach-achlorhydria, chronic gastritis or diarrhea, peptic ulcer
 C. Hookworm disease
 *D. Liver disease, such as chronic cirrhosis
 E. Malaria
 F. Pregnancy
 G. Pulmonary tuberculosis
 H. Skin disorders, such as pityriasis rubra pilaris
 *I. Thyroid gland disorder, such as hyperthyroidism
 J. Uyemura syndrome (fundus albipunctatus with hemeralopia and xerosis)

8. Decrease tear production

 A. Congenital alacrima
 B. Keratoconjunctivitis sicca
 C. Riley-Day syndrome (familial dysautonomia)
 D. Sjögren syndrome
 E. Surgical excision of the lacrimal and accessory lacrimal glands
 F. X-irradiation of the lacrimal gland

9. Following x-irradiation of the conjunctiva

Fraunfelder FT, Fraunfelder FW. Drug-induced ocular side effects. Woburn, MA: Butterworth-Heinemann, 2001.

Gilbert JM, et al. Ocular manifestations and impression cytology of anorexia nervosa. Ophthalmology 1990; 97: 1001.

Newell FW. Ophthalmology: principles and concepts, 7th ed. St. Louis: CV Mosby, 1991.

Roy FH. Ocular syndromes and systemic diseases, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2002.