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  5. FP0866 : “Cry for tears” An early Ophthalmic manifestation in Allgrove (Triple A) syndrome

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Chief Author: Dr.Fatema Lokhandwala

Presenting Author: Dr.Simran

Co Author(s): Dr.Simran, Dr.Urmila Rawat

Abstract

22 years old female presented with complaints of absent tear production and cried without tears since birth. On double eversion of eyelids, atrophied palpebral lobe of the lacrimal gland was noted. Diagnosis of alacrima was made. Vision was 6/9 on Snellen’s visual acuity chart in both eyes. Slit lamp evaluation revealed decreased tear meniscus in both eyes with mild superficial punctate keratopathy in the left eye, for which the patient was advised frequent lubrication. Schirmer testing results with anesthesia were 5mm in both eyes. Both pupils were tested with 0.125% pilocarpine and showed constriction. She had history of delayed puberty and failure to thrive suggestive of ACTH deficiency. Further history revealed multiple episodes of vomiting. Diagnosis of achlasia was confirmed and laproscopic Heller’s myotomy was performed. Given the classical triad of achalasia, alacrima and ACTH resistant adrenal insufficiency, a diagnosis of Allgroves (Triple A) syndrome was made.