The second category of tear film deficiency is non-sjogrens syndrome which can be divided into:
1- Age related which is the most common cause and mainly it occur after the age of 50 especially in female after menopause due to hormonal changes.
2- Destruction to lacrimal gland like in infiltrative process or in infectious process, after surgical removal or after radiation of head and neck. Infiltrative process as in sarcoidosis, lymphoma or amyloidosis.Infectious process as in trachoma
3- Obstruction to lacrimal gland ducts which can occur after infection, conjunctival scarring which can occur following trachoma and cicatricial pemphigoid
4- Neurological lesions with decrease sensation of the cornea like Parkinson disease, multiple sclerosis, Bells palsy and Alzheimer disease