Dry Eye In Children Research Articles

Effects of common eye diseases in children and their treatment measures on ocular surface homeostasis: A review.

Ocular surface homeostasis plays a vital role in maintaining of eye health. Dry eye disease is one of the prominent and typical manifestations of disruption of ocular surface homeostasis that leads to the worsening of ocular surface homeostasis that leads to the worsening of ocular surface disease when it interacts with other pathogenic factors. However, disruption in ocular surface homeostasis in children is often overlooked because of the current methods of assessing ocular surface homeostasis. This review summarizes the main factors affecting ocular surface homeostasis in children, with the aim of drawing the attention of clinicians to the disruption of ocular surface homeostasis in children when dealing with such diseases. Ocular surface homeostasis involves several interrelated components, each of which plays a nonnegligible role in ocular surface homeostasis. Unlike adults, children have a stronger lacrimal gland secretion capacity and milder symptoms when there is a slight disruption of the ocular surface homeostasis. In addition, children's expressive abilities were weaker. Therefore, dry eye in children is often ignored by doctors and parents, and clinicians should pay more attention to the protection of ocular surface homeostasis when treating children with these diseases. Therefore, there is a need for diagnostic criteria for dry eye disease specific to children.

Severe dry eye due to isolated bilateral lacrimal gland agenesis in a child. A challenging case report and review of the literature

We present a challenging case of severe dry eye secondary to alacrimia due to bilateral lacrimal gland agenesis (LGA) in a child and its successful treatment. A 7-year-old girl presented with symptoms and findings of severe dry eye and keratitis. Systemic associations were excluded, and orbit imaging demonstrated bilateral LGA. Treatment with punctal occlusion, blood-derived and preservative-free eye drops, and PROSE® system/scleral contact lens proved an excellent clinical result. Lacrimal gland hypoplasia is a rare cause of severe dry eye in children. Prompt diagnosis and integral treatment are crucial to reverse ocular surface damage and allow patients to return to their daily activities.

Symptoms and signs of dry eye in children with Graves' ophthalmopathy.

The purpose of this study is to evaluate the tear secretion and ocular surface properties in children with Graves' ophthalmopathy (GO) and to compare the results with those of healthy children. This was a cross-sectional study. Forty-three patients with GO (Group 1) and 41 healthy children without any ocular and/or systemic disorder (Group 2) were examined clinically and underwent tests for dry eye. We performed analyses including the Ocular Surface Disease Index (OSDI) questionnaire, Schirmer's test under topical anesthesia (<5 mm was abnormal), slit-lamp biomicroscopy (corneal fluorescein staining and tear breakup time (TBUT) under blue-light illumination), and fundoscopic evaluation. Dry eye symptoms and the mean OSDI score were significantly (P < 0.02) higher (15.6 ± 18.7) in patients with GO compared with controls (5.67 ± 3.6). The mean Schirmer's (basal tear secretion) tests value was significantly reduced in Group 1 (5.25 ± 3.1 mm) compared with Group 2 (17.1 ± 5.2), respectively. The difference was statistically significant (p < 0.005), suggesting inadequate tear production. The mean tear film breakup time in children was lower in patients with GO (8.3 ± 3.42 s,) compared with controls (13.2 ± 4.74 s), (P < 0.001) suggesting an unstable tear film. Decrease of corneal sensitivity (23.3%) was noted in patients with GO compared with controls. GO patients showed a significant increase of the frequency of corneal fluorescein staining (6.9%) in patients with GO compared with controls. Patients with GO had a statistically significant higher incidence of dry eye symptoms and the increase of OSDI score. Significantly lower Schirmer's and TBUT tests results were seen in the study group when compared with the controls. These findings may indicate a tendency for dry eye in pediatric GO patients.

Assessment of dry eye in pediatric population along with ocular surface disorder and visual display terminal

Background: Dry eye is a disease condition wherein the ocular surface is either not uniformly or not completely lubricated by tear film. Dry eye is less prevalent in children, but if observed it may be a manifestation of conditions like Steven Jonson syndrome, Sjogren’s syndrome, blepharitis, MGD or VKC. Therefore, evaluation of dry eye may aid in effective and timely treatment of other life-threatening diseases in children. Aim of current study was determination of dry eye in pediatrics and to investigate its association with ocular surface disorders like MGD, VKC and VDT.Methods: A prospective observational study was conducted on 400 patients. All patients were screened for OSDI and patients having index score &gt;11 were investigated for dry eye disease, based on inter blink interval and tear-film breakup time determined using slit lamp and through Schirmer’s test. Dry eye patients were further investigated to determine type and causative factors for dry eye.Results: 25 patients exhibited bilateral dry eye with &gt;12 score. Children of age group 7-18 years were commonly affected. Diseases commonly observed to be associated with dry eye in children were VKC, MGD, or visual display terminal caused due to over use of smart phone and digital screen.Conclusions: The evaporative dry eye due to MGD and VDT is more common in pediatric age group in comparison to aqueous deficiency dry eye. Overuse of smart phones, tablets or computers increases the prevalence of dry eye which inturn affect their outdoor activity, studies and over all development of children.

Microbiological Characteristics of Ocular Surface Associated With Dry Eye in Children and Adolescents With Diabetes Mellitus.

To analyze the characteristics of ocular surface microbial composition in children and adolescents with diabetes mellitus and dry eye (DE) by tear analysis. We selected 65 children and adolescents aged 8 to 16 years with DE and non-DE diabetes mellitus and 33 healthy children in the same age group from the Shanghai Children and Adolescent Diabetes Eye Study. Tears were collected for high-throughput sequencing of the V3 and V4 region of 16S rRNA. The ocular surface microbiota in diabetic DE (DM-DE; n = 31), diabetic with non-DE (DM-NDE; n = 34), and healthy (NDM; n = 33) groups were studied. QIIME2 software was used to analyze the microbiota of each group. The DM-DE group had the highest amplicon sequence variants, and the differences in α-diversity and β-diversity of micro-organisms in the ocular surfaces of DM-DE, diabetic with non-DE, and healthy eyes were statistically significant (P < 0.05). Bacteroidetes (15.6%), Tenericutes (9.3%), Firmicutes (21.8%), and Lactococcus (7.9%), Bacteroides (7.8%), Acinetobacter (3.9%), Clostridium (0.8%), Lactobacillus (0.8%) and Streptococcus (0.2%) were the specific phyla and genera, respectively, in the DM-DE group. Compared with the patients with non-DE and healthy children, the microbial diversity of the ocular surface in children and adolescents with diabetes mellitus and DE was higher with unique bacterial phyla and genera composition.

Children’s vision health during the COVID-19 pandemic

During the peak months of the COVID-19 pandemic, several countries elected to close schools and adapted to online learning. The aim of the article is to review the impact of lockdown measures instituted during the COVID-19 pandemic on children’s vision health and to make recommendations for mitigating potential visual impairment. Methods: We reviewed studies focused on digital device usage, near work, and outdoor time in relation to myopia onset and progression in children during the COVID-19 pandemic. Studies focused on the relation between screen time, asthenopia and dry eyes in children during COVID-19. Results: Increased digital screen time, near work and limited outdoor activities were found to be associated with the onset and progression of myopia during the COVID-19 pandemic period. Screen time was positively associated with asthenopia and dry eye in children during COVID-19. Conclusion: The COVID-19 pandemic has led to dramatic changes in many aspects of daily life. Online learning has become the mainstream public learning mode during the pandemic. Several studies indicate accelerated myopic progression during the COVID-19 pandemic in children and the increase has been found to be related to excessive use of digital screen devices and the decrease of outdoor activities duration. Also prolonged screen time, and online-course time can significantly increase asthenopia and dry eye risk. Several studies have recommended to decrease screen time and to increase outdoor activities. Key words: Myopia progression, digital screen time, near work, outdoor activity time, asthenopia and dry eye

Questionnaire Analysis on Incidence and Risk Factors of Dry Eye in Children From a Myopia Outpatient Clinic.

ObjectiveTo analyze the incidence and risk factors of dry eye in children from a myopia outpatient clinic via a questionnaire and Keratograph 5M.MethodsA cross–sectional study was performed. sThere were 214 children (428 eyes) selected from the myopia outpatient clinic of the affiliated Eye Hospital of Shandong First Medical University from July 2021 to September 2021, including 105 boys (210 eyes) and 109 girls (218 eyes), with an average age of 10.1 ± 2.5 years. The incidence rate and influence factors for dry eye were calculated.ResultsThirty–four of 214 children were diagnosed with dry eye, accounting for 15.9% of the patients. The correlation between fussy eating and the tear meniscus height was statistically significant (Z = −2.158, p = 0.039), along with the correlation between short–distance use of eyes and the tear meniscus height (Z = −2.135, p = 0.033). The degree of meibomian gland deficiency was graded. The meibomian gland was graded as grade 1 in 242 eyes (68.9%), grade 2 in 104 eyes (29.6%), and grade 3 in 5 eyes (1.4%). There was a significant difference in the correlation between eye rubbing and the incidence of dry eye in children (Z = −2.747, p = 0.008). There was also a significant difference in the correlation between picky eating and the incidence of dry eye in children (Z = −2.347; p = 0.024). There was a statistically significant correlation between the time of looking at electronic products and the morphology of the meibomian gland (Z = −2.201, p = 0.028). The results showed that the effect of mild and moderate ametropia on the non–invasive tear breakup time in children was statistically significant (Z = −2.027; p = 0.043).ConclusionThere is a high incidence of dry eye in children in the myopia outpatient clinic. There is a significant correlation between picky eating, eye rubbing, and the incidence of dry eye. Looking at electronic products for a long time will also affect the morphology of the meibomian gland in children.

Incidence and Risk Factors of Dry Eye in Children and Adolescents With Diabetes Mellitus: A 3-Year Follow-Up Study.

Purpose: To investigate the incidence and risk factors of dry eye in children with diabetes mellitus (DM) over a period of 3 years.Methods: Children and adolescents with DM (age: 3–14 years) from the Shanghai Children and Adolescent Diabetes Eye (SCADE) study cohort who did not have dry eye in January 2018 were followed-up for 3 years and re-examined in January 2021, and the incidence rate and risk factors for dry eye were calculated.Results: Forty children and adolescents with DM came for follow-up in 2021. Nine of them were diagnosed with dry eye, resulting in a 3-year incidence rate of 22.5% and an annual mean incidence rate of 7.5% for dry eye. Univariate regression analysis confirmed that decreased corneal sensation (OR [Odds Ratio] = 25.60; 95%CI [Confidence Interval] = 1.31~501.69; P = 0.03) was the risk factor for dry eye incidence. Long course of DM (OR = 1.80; 95%CI = 0.96~3.38; P = 0.07), eye pain (OR = 12.27; 95%CI = 0.65~231.48; P = 0.09), and dry eye in parents (OR = 15.99; 95%CI = 0.76~337.75; P = 0.08) may interfere with the incidence of dry eye in them.Conclusions: The incidence of dry eye in children and adolescents with DM is high.

Dry Eye in Children: An Occult Public Health Crisis Exacerbated by the COVID-19 Pandemic

Dry Eye in Children: An Occult Public Health Crisis Exacerbated by the COVID-19 Pandemic

Dry Eye Disease Practice in Ghana: Diagnostic Perspectives, Treatment Modalities, and Challenges

There is a dearth of studies investigating the challenges encountered in dry eye practice. Profiling these barriers is crucial to improving dry eye diagnosis and patient care. This study aimed to examine the diagnostic and treatment perspectives, and challenges in dry eye practice in Ghana. An anonymous paper-based or web survey regarding dry eye practice pattern, practice challenges, and access to diagnostic tools was distributed to 280 potential participants. One hundred thirteen respondents completed the survey. Case history (92.5%), fluorescein tear breakup time (87.5%), and corneal fluorescein staining (72.5%) were the topmost procedures used for dry eye diagnosis. A preserved lubricant drop was the most commonly prescribed treatment of mild, moderate, and severe dry eye at the rates of 77.0, 83.2, and 77.0%, respectively. A few respondents prescribed cyclosporine (2.7%) or punctal plugs (5.3%) across all disease severities, and none used scleral lens, autologous serum tears, or thermal pulsation. Graduate professional training influenced the practice pattern of 82.3% of respondents, whereas continuing professional education influenced less than 1%. Approximately 70.1 and 92.8% of optometrists considered referring dry eye in children and cases that are unresponsive to treatment, respectively. Eighty-eight percent of practitioners indicated they experience a challenge in dry eye practice, with limited access to diagnostic tools (77.9%) and limited availability of effective dry eye medication on the Ghanaian market (50.4%) being the most frequent challenges. More than 85% of respondents had access to a fluorescein dye or slit-lamp biomicroscope; however, none had access to a phenol red thread, lissamine green dye, osmolarity technology, or meibography device. Practitioners' limited access to diagnostic tools/techniques and the limited effective dry eye treatments are major challenges encountered in dry eye practice in Ghana. Addressing these will improve dry eye practice and treatment outcomes in the country.

Isolated bilateral congenital lacrimal gland agenesis presenting as dry eye in childhood: a rare entity

We report the case of a 1-year-old child who presented with complaints of redness and defective vision since birth. The child had no systemic abnormalities. On examination, complete keratinization of the bulbar conjunctiva and cornea was noted with dry, lustreless and irregular surface. Corneal sensation was intact. Orbital MRI revealed bilateral agenesis of the lacrimal gland with normal salivary glands. The child was given vitamin supplementation, cyclosporine eye drops along with lubricants and tape tarsorrhaphy in the night. Permanent occlusion of both the lower puncta was done. There was decreased ocular surface congestion, with frequent wetting of the ocular surface, which continued in the months to follow. We present a case of isolated bilateral lacrimal gland agenesis with normal salivary glands, a rare cause of dry eye in children. An early diagnosis and conservative management can help in maintaining functional vision in such cases.

Passive Smoking as a Risk Factor for Dry Eye in Children

Passive Smoking as a Risk Factor for Dry Eye in Children

Research progress on related factors of dry eye in children

Research progress on related factors of dry eye in children

Pay attention to the diagnosis and treatment of dry eye in children

Dry eye has become the most common ocular surface disease in China's clinical ophthalmology. However, dry eye in children has not achieved enough attention. It lacks related information of basic data and diagnostic criteria, and there is no standard for the clinical diagnosis and treatment. As dry eye in children has its own characteristics, its diagnosis and treatment are not exactly the same as adults. In recent years, due to the popularization and widespread usage of electronic products, coupled with some systemic factors, the incidence of dry eye in children has risen rapidly. To this end, it is urgent to improve the level of clinical diagnosis and treatment of dry eye in children in China, to establish the relevant basic data, to strengthen the basic research, and to promote the prevention and treatment of dry eye in children. (Chin J Ophthalmol, 2018, 54: 406-408).

Cyclosporine 0.05% ophthalmic emulsion for the treatment of radiation‐associated dry eye in children

Dry eye disease is a well-known late complication of radiation therapy and is often difficult to treat. We evaluated the usefulness of cyclosporine 0.05% ophthalmic emulsion for the treatment of radiation-associated dry eye in children. Eleven children received cyclosporine 0.05% emulsion twice daily after failure of conventional therapy. After 6 months, dry eye manifestations improved in three children (27.3%). The remaining eight children showed no improvement with cyclosporine 0.05% ophthalmic emulsion. These results suggest that twice-daily cyclosporine 0.05% ophthalmic emulsion has limited use in children with refractory radiation-associated chronic dry eye.

Passive smoking as a risk factor of dry eye in children.

Purpose. Adult active smoking is a risk factor for dry eye. We hypothesize that passive smoking in children can also produce the same effects. Methods. We included 112 school children presenting with eye discomfort. Assessment of eye dryness and its severity levels depending on symptoms of dry eye, visual symptoms, tear breakup time (TBUT), Schirmer-1 test, and corneal fluorescein staining were done for all of them. Exposure to cigarette smoking was assessed by history-taking and urinary cotinine levels. Results. Dry eye was found in 80/112 children. Passive smoking was documented in 76/112 children. Number of cigarettes to which the child was exposed per day and the duration of exposure to passive smoking were significantly higher in children with dry eye compared to those without. Urinary cotinine, and cotinine/creatinine ratio (CCR) was significantly higher in children with dry eye compared to those without dry eye. Multiregression analysis showed that the most important determinants of dry eye were CCR and number of cigarettes/day. Conclusion. Passive smoking represents a significant risk factor of dry eye in children comparable to that shown with active adult smoking. Male children are more prone to this effect.

Recent developments of dry eye in children

Abstract Purpose Dry eye syndrome in children is a rare disease sometimes difficult to diagnose. The research of the etiology can contribute to adjust the treatment. Methods Two features of dry eye syndrome in children can be distinguished. Dry eye integrated in general disease with evidence of diagnosis and etiology and asymptomatic dry eye which needs a careful check up to recognize the primary etiology. Keratitis sicca usually does not lead to children complaint and simple signs as rubbing or blinking are often observed. Clinical and practical cases are described. Results Review of literature confirms common conditions with adult dry eye but also the specificity of the pediatric dry eye. Dry eye in children is also commonly an inflammatory condition of the ocular surface. New treatment with their indications are listed including tear‐like topical therapies and anti‐inflammatory or immunosuppressive drugs for ocular surface with specificities in children. Conclusion Dry eye syndrome in children must be recognized and diagnosed. In addition to classical tear‐like treatment, specific therapy should be adapted to the etiology.

Dry Eye in Childhood: Epidemiological and Clinical Aspects

Because dry eye disease is rare in children and its pathogenesis is less well known than in adults, its diagnosis is often overlooked. It can occur in association with a number of congenital, autoimmune, endocrine, and inflammatory disorders, or under certain environmental and nutritional conditions. In some cases, early detection allows the underlying cause of the dry eye to be successfully treated and eliminated. In other cases, the disease may represent a lifelong problem, whose proper management can prevent ulceration and scarring of the ocular surface. Because of the association of pediatric dry eye with other conditions, a multidisciplinary approach to diagnosis and treatment is usually required. The purpose of this review is to enhance physician awareness of dry eye in children, to describe the most frequently associated conditions, and to discuss the diagnostic and therapeutic options available.

Management of dry eye related to systemic diseases in childhood and longterm follow‐up

Dry eye in children is not common in general practice and is usually referred to tertiary centres for diagnostic confirmation. In the present review we examine the potential causes of dry eye in children and report the management and longterm follow-up of dry eye in childhood with reference to clinical diversity, systemic associations, ocular outcomes and treatment trends. A retrospective, consecutive case series was studied by evaluating the clinical charts of children with dry eye over a 96-month period. Minimal diagnostic inclusion criteria were presence of ocular surface damage and tear deficiency. Fourteen patients with an age range at presentation of 1-17 years were evaluated. Ten patients were female, four were male and all had bilateral involvement. The most frequent symptoms were red eye, photophobia and low visual acuity (VA). Four patients had corneal ulcers. Two patients had best corrected visual acuity (BCVA) < or = 20/200 at first examination. One of these plus another patient presented with BCVA < or = 20/200 at the last visit. All patients were treated with artificial tears; three received autologous serum tears and five submitted to conjunctival flaps to preserve the integrity of the eye. Associated systemic conditions were found in all patients and were congenital in six of them. Early manifestations of dry eye in childhood are a potential indication of systemic disease. The ocular condition may be misdiagnosed and correct treatment delayed. Most diseases are bilateral and may jeopardize VA. Systemic investigation, close follow-up and preparing the family for longterm and multidisciplinary treatment are necessary to preserve ocular health and identify systemic associations.

This issue of Acta

This issue of Acta focuses on paediatric ophthalmology and the retina. The cover figure shows a child with unilateral cataract and strabismus and comes from the review article by Charlotta Zetterström and Maria Kugelberg, of Oslo and Stockholm, respectively. The editorial is written by Michael O’Keefe in Dublin and discusses intraocular lenses in children. This relates directly to the review on paediatric cataract surgery by Zetterström and Kugelberg. The other review paper published in this issue, by Gunnar Lennerstrand, of Stockholm, discusses strabismus and eye muscle function. Together, the two articles present a comprehensive review of these two important subjects in paediatric ophthalmology. Continuing with the subject of paediatric ophthalmology, Fahnehjelm et al., based in Stockholm, examined the ocular effects of stem cell transplantation in the context of paediatric cancer treatment. The visual function of the children in their sample was generally good, but the majority developed cataracts to some degree. Hoerantner et al., writing from Austria, compared two surgical techniques for treatment of strabismus that requires ocular motor torque reduction. An investigation carried out in Brazil by Medina et al. found that dry eye in children is frequently associated with systemic disease. Longterm treatment is necessary to preserve ocular health and vision. Based in Stockholm and China, Zhang et al. found that cataract development following ultraviolet irradiation may depend on the type of anaesthetic used in the experimental rats. Coma et al., writing from the USA and Spain, found an association between tumour necrosis factor α and ocular cicatricial pemphigoid and suggest that a causal relationship may be present. Lundström et al., in Umeå and Shanghai, investigated the oscillatory potentials in the human electroretinogram. They observed that the oscillatory response may be activated by a single flash after dark adaptation, that adaptation to mesoptic background light does not change the response and that the response reflects a neuronal adaptation to a change in light level. German authors Meyer et al. present a thorough investigation of the visual and haemodynamic effects of racemose haemangioma. UK-based Higgings and associates, of Liverpool, revisited the importance of controlling risk factors for diabetic retinopathy and found that, despite well established scientific knowledge, many diabetes patients have poorly controlled blood pressure and glucose levels. Wimpissinger and Binder, reporting from Vienna, found sclerotomy-related retinal detachments in 11 of 244 pars plana vitrectomies and suggest that this complication may be prevented with meticulous cleaning of the vitreous base and postoperative examination of the entry sites. Kotliar and associates, based in Germany and Russia, examine the physics of intravitreal injections and the intraocular pressure peak that immediately follows such an injection. Korean researchers Oh et al. found that triamcinolone inhibits the proliferation of fibroblasts and retinal pigment epithelial cells in vitro. Akkoyun et al., writing from Ankara, report their findings that triamcinolone suppresses the proliferation endothelial cells in vivo in a mouse model of retinopathy of prematurity. Paris-based Lecleire-Collet and associates present a case where diabetic cystoid macular oedema treated with triamcinolone injection ended with a full-thickness macular hole. Brazilian authors Cella and Ávila evaluated branch retinal artery occlusion with the help of optical coherence tomography. I hope that all readers find material that is useful, interesting and stimulating in this issue of Acta and that we may use this issue of the journal to refresh our knowledge of paediatric ophthalmology.