Is the lacrimal gland dispensable? Keratoconjunctivitis sicca after lacrimal gland removal

A persistent, unilateral keratoconjunctivitis sicca developed immediately after palpebral dacryoadenectomy in a healthy 43-year-old woman with normal eyes and tear function before the operation. The unoperated on fellow eye remained normal during a ten-year period. Eight similar cases are collected from the literature. On the basis of the presented cases, we believe that the main lacrimal gland is an indispensable element of the tear system, and the accessory lacrimal glands are unable normally to prevent tear insufficiency.