This is a common problem caused by a reduction in the quality and/or quantity of the tear film. It occurs more commonly as a person ages, in women more often than men, those with lid closer problems and those with autoimmune disorders such as rheumatoid arthritis, Sjogren's syndrome, lupus, ocular cicatricial pemphigoid and Steven-Johnson syndrome. It can also be seen following refractive surgery. Treatment includes artificial tears, medications and punctal occlusion