Is my Child Suffering From Dry Eye?
While dry eye disease has been around for decades, its prevalence in the last decade cannot be ignored. Current statistics estimate that upwards of 6 million Canadians suffer from dry eye disease. And those are only the diagnosed cases.
Although there is little data available on the prevalence of dry eye in children, pediatric dry eye is a very real condition. In fact, I seemingly perform more dry eye assessment examinations on my younger patients every single day.
So as a parent, what should you look for and is there a solution? And as an optometrist, how do I best diagnose and treat dry eye? We’ll discuss everything you need to know about dry eye and how it affects your children.
Symptoms of Dry Eye
Depending on the age of your child, they may not be able to communicate the discomfort they feel from having dry eyes. So as parents, it is important to pay attention and watch for the following signs:
- Frequent blinking and squinting
- Constant eye rubbing
- Redness around the eyes
- Gritty or sandy feeling in the eye
- Itchy eyes
- Sensitivity to light
- Intermittent blurred vision
If your child is exhibiting one or more of the above behaviours, they may have dry eye. Make an appointment with your optometrist as soon as possible to discuss these symptoms and treatment options.
Diagnosing Dry Eye in Children
When a child comes into our clinic complaining of dry eye or their parents have noticed suspicious symptoms, it is my job to find out exactly what is going on. Some of the tests I conduct to diagnose dry eye in children include:
Schirmer’s Test
A common dry eye test is the Schirmer’s test, which determines whether a person’s eyes produce enough tears to keep their eyes moist. A piece of filter paper is placed inside the lower eyelid of both eyes, the patient closes their eyes for a few minutes, then the paper is removed. Then how far the tears have travelled on the paper is measured.
Depending on the age of the child, conducting this test can be challenging. Some children cannot sit still for the duration of the exam and the paper is uncomfortable on their eyes, causing excessive blinking and reflex tearing.
Slit Lamp Exam
Depending on the patient, this exam is conducted with and without the use of fluorescein or dilating eye drops. Sitting in the examination chair, the patient then rests their chin and forehead against an instrument that uses a low-powered microscope and high-intensity light to examine all areas of the eye. In addition to diagnosing macular degeneration, detached retina, and cataracts, the slit lamp test allows us to properly diagnose and detect dry eye.
Tear Break Up Time (TBUT) Test
The TBUT measures the stability of the tear film. I insert fluorescein sodium into the patient’s eyes, have them hold their eye open for 10 seconds, and measure the results. Typically if a dry area appears in their tear film within the 10-second time frame, they may have dry eye.
The fluorescein also allows us to detect stain patterns and corneal abrasions that may be consistent with dry eye.
Dry Eye in Children: What are the Causes & Solutions?
So how do we explain the sudden surge of dry eye in children? There are many root causes at play, each one with a possible solution.
Contact Lenses
CAUSE:
If your child wears contact lenses, they simply may not be the right contact lens for their eye. Not every contact lens is created equal – and it is common practice to test out several brands before settling on the perfect one.
SOLUTION:
If you suspect your child’s dry eye is related to improper lenses, talk to your optometrist. They can suggest other alternatives such as daily disposables, or contacts with hydrogels that maintain moisture for longer periods.
Digital Eye Strain
CAUSE:
As parents, we know excess of screen time has been linked to obesity, irregular sleep schedules, behavioural problems, and more. We can now add dry eyes to that list.
Digital eye strain is becoming an increasing problem in today’s technological world. Whether its phones, gaming devices, or a personal computer, staring at an electronic device for long periods can dry the cornea.
SOLUTION:
We suggest limiting screen time and having your child follow the 20/20/20 rule and take breaks from their device frequently.
Blepharitis
CAUSE:
Blepharitis is an inflammation of the oil glands of the eyelid most commonly caused by bacteria or abnormal production and secretion of these oil glands. Along with inflammation and crusts around the eyelashes, blepharitis can cause loss of eyelashes and dry eye.
SOLUTION:
BlephEx is an in-office procedure that removes debris from the eyelids. While it is safe for patients of all ages, I don’t recommend BlephEx for very small children, as they must be able to sit somewhat still during the treatment. However, for older children, it can be an excellent option against blepharitis and dry eye.
Medical Conditions and Medications
CAUSE:
There are several medical conditions directly correlated to dry eye symptoms.
Several inflammatory conditions, such as Sjogren’s syndrome and juvenile rheumatoid arthritis have been linked to pediatric dry eye. Similarly, the prevalence of dry eye in children with diabetes is greater in recently conducted studies. Poor nutrition and congenital disorders are other conditions associated with dry eye.
If your child is taking medication for the above conditions or other reasons, the medications themselves may be the root cause of their dry eye. In fact, many common medications have dry eye as a listed side effect. Some of these include:
- Antihistamines taken for allergies
- Acne medications that lower oil production
- Antidepressants and other drugs that block signals between nerve cells and the brain
SOLUTION:
Talk to your doctor about your child’s dry eye symptoms and all current medications your child is taking. There are often alternatives to common drugs that have different side effects that your doctor may prescribe.
In addition, preservative-free artificial tears are a safe way to restore moisture and nourishment to the eye. Foods rich in omega-3 fatty acids and vitamin C and E have been shown to prevent oil in our tear film from drying up too quickly. In addition to adding fish, citrus, nuts and seeds, and leafy green vegetables to your diet, omega-3 supplements may also be taken. Do your research and talk to your optometrist before giving any supplements to your children.
Future Treatment Strategies
Eyes are my passion. I am continuously keeping up with advancements in overall eye care and am particularly interested in research studies relating to dry eye. Of them, there are a few strategies for children that are proving interesting. While research is still in the infancy stage, two new dry eye treatments for children I am keeping my eye on include:
PROSE Lenses
Developed at the Boston Foundation for Sight, PROSE lenses are permanent, custom-made, gas-permeable lenses that vault the cornea, retaining a layer of tears over the corneal surface. While it is used only for patients with severe ocular diseases, it’s gaining traction as an effective dry eye treatment for adults as well as showing promise in children.
Punctal Plugs
Although punctal plugs are a common therapy for dry eye in adults, to date it has rarely been considered for children. However, studies evaluating the safety and efficacy of punctal plugs in children with dry eye are ongoing with some trials concluding they offer a safe and effective form of dry eye treatment for children.
