Our syndrome is not “on the list.” Still worth a consult?

Yes — the lens responds to the surface, not the syndrome’s name. If tears are the missing piece, the mechanism applies.

Can children wear scleral lenses?

With training and family support, many do very well — handling becomes routine faster than parents expect.

Does this replace our other treatments?

No — it anchors them. Serum tears, ointments and specialist care usually continue, working better on a protected surface.

What is Triple A syndrome?

Triple A syndrome, also called Allgrove syndrome, is a rare inherited condition named for three features: achalasia (trouble moving food down the esophagus), adrenal insufficiency (the adrenal glands make too little hormone) and alacrima, meaning tear production is reduced or absent. Alacrima is often the first sign noticed in babies. The condition is estimated to affect 1 in 1 million people. Dr. Brandon Cohenmehr, OD, authored a case report on scleral lenses for a patient whose Triple A syndrome caused extreme tear deficiency.

Can scleral lenses work if my eyes make almost no tears?

Yes. The lens brings its own fluid: before it goes in, its bowl is filled with preservative-free saline, so your cornea sits in a saline bath for as long as the lens is worn. That reservoir keeps the surface hydrated and physically protected, which is why scleral lenses are prescribed for severe dry eye and other ocular surface disease (conditions that damage the surface of the eye). For these eyes, fitting is done gently and in stages from an Eaglet Eye Surface Profiler map.

Medically reviewed by Dr. Brandon Cohenmehr, OD Last reviewed October 24, 2026

Scleral Lenses for Rare Tear Deficiency

When drops replace nothing, wear the tears instead.

A handful of rare conditions all arrive at the same cruel place: almost no natural tears at all. For those eyes, drops are a losing race. A scleral lens changes the game — the eye spends its day inside a reservoir, and the tear film is simply worn.

Book appointmentOr call 310-828-2010 Accepted insurance

The problem: Near-zero tear production
The causes: Congenital & neurologic syndromes
The reframe: Wear the tear film
The precedent: Published from this practice

The published case

An A+ solution, in the literature.

Dr. Brandon Cohenmehr authored the scleral lens case report “An A+ Solution to Triple A Syndrome: Scleral Lenses”. It documents restored comfort and function in a patient whose rare condition caused extreme tear deficiency. The report shows the idea behind this page: when physiology won’t make a tear film, engineering can hold one in place.

Who this serves: Patients with congenital or syndromic tear deficiency, nerve-related low production, and the severest aqueous-deficient dry eye. They are often young and often told nothing more could be done.
What changes: Burning gives way to hours of quiet; surfaces that constantly broke down get to heal under fluid; school and work days stop being rationed.
How we fit it: Gently and in stages, from an Eaglet ESP map — with serum tears, membranes and your other specialists coordinated around the lens, not displaced by it.

For the families

Rare doesn’t mean alone.

Evaluations welcome from anywhere, with visit clusters for travelers
Records coordinated with your existing specialists
The goal is boring: comfortable, repeatable days

Book a consult

Common questions

Rare tear deficiency, answered.

Anything else, call the office at 310-828-2010.

Yes — the lens responds to the surface, not the syndrome’s name. If tears are the missing piece, the mechanism applies.
With training and family support, many do very well — handling becomes routine faster than parents expect.
No — it anchors them. Serum tears, ointments and specialist care usually continue, working better on a protected surface.
Triple A syndrome, also called Allgrove syndrome, is a rare inherited condition named for three features: achalasia (trouble moving food down the esophagus), adrenal insufficiency (the adrenal glands make too little hormone) and alacrima, meaning tear production is reduced or absent. Alacrima is often the first sign noticed in babies. The condition is estimated to affect 1 in 1 million people. Dr. Brandon Cohenmehr, OD, authored a case report on scleral lenses for a patient whose Triple A syndrome caused extreme tear deficiency.
Yes. The lens brings its own fluid: before it goes in, its bowl is filled with preservative-free saline, so your cornea sits in a saline bath for as long as the lens is worn. That reservoir keeps the surface hydrated and physically protected, which is why scleral lenses are prescribed for severe dry eye and other ocular surface disease (conditions that damage the surface of the eye). For these eyes, fitting is done gently and in stages from an Eaglet Eye Surface Profiler map.

Rare tear deficiency near you

12222 Wilshire Blvd, on the Santa Monica border.

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Next step

Out of conventional road?

Bring the diagnosis, however rare — the mapping visit with a Los Angeles eye doctor speaks surface, not syndrome.

Book a consult Or call 310-828-2010