A patient can have dry eye despite adequate tear production. Marube et al term this type "tantalic" after a Tantalus, a mythologic son of Zeus who was constantly thirsty despite being immersed in water.


This form of dry eye can occur despite adequate tear production, or it can coexist with other forms of dry eye.


It may be unilateral or bilateral.



(1) epitheliopathies that interfere with tear film production and/or retention

(2) lid and/or globe pathology that interferes with spreading of the tear film over the globe

(3) environment-related hyperevaporative states, typically involving some combination of very low humidity, hot weather, and/or rapid air movement (wind, fan, etc)


Epitheliopathies include:

(1) abnormalities of the corneal epithelium (dystrophy, etc)

(2) diabetic keratitis

(3) keratitis associated with hypoparathyroidism

(4) epithelial dystrophy

(5) limbal deficiency


Lid-globe pathologies that can prevent an even distribution of a tear film include:

(1) lid coloboma

(2) ectropion

(3) lagophthalmos

(4) lid palsy

(5) exophthalmos

(6) floppy lid

(7) benign cysts

(9) pterygion

(10) fissure in the eyelid


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