ANSWER to guess the diagnosis: MEN 2B (Multiple Endocrine Neoplasia Type 2B). The picture shown here along with the patient's history of problems making tears in a child is most likely MEN 2B. This is a syndrome where there is a mutation in the RET gene, which then affects multiple organs.What's important about this timely diagnosis is that ❗98% ‼️ of these patients will have medullary thyroid cancer in childhood! (An elevated Calcitonin in blood test will confirm this diagnosis in this setting)