ArticleLiterature Review

Dry Eye in Childhood: Epidemiological and Clinical Aspects

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Abstract

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.

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... Very few publications have described management strategies for DED in the young population, beyond the use of unpreserved lubricants or artificial tears and environmental modifications in line with adult therapy [5,63]. Safety and efficacy have not been established for most pharmacological or natural agents in children, although there is some safety evidence based on use of steroids, for example, in allergic eye disease in children [64]. ...
... In more severe disease, such as that associated with autoimmune diseases, oral cyclosporine A or methotrexate have been used to treat immune suppression in conjunction with unpreserved lubricants, topical autologous serum and/or topical cyclosporine A [9,57,63,66,67]. Topical steroids may be used to treat inflammation, although care must be taken to limit the side effects of raised intraocular pressure and posterior subcapsular cataracts [63]. Systemic antibiotic treatment for MGD has not been deemed safe for children. ...
... In more severe disease, such as that associated with autoimmune diseases, oral cyclosporine A or methotrexate have been used to treat immune suppression in conjunction with unpreserved lubricants, topical autologous serum and/or topical cyclosporine A [9,57,63,66,67]. Topical steroids may be used to treat inflammation, although care must be taken to limit the side effects of raised intraocular pressure and posterior subcapsular cataracts [63]. Systemic antibiotic treatment for MGD has not been deemed safe for children. ...
... Many potential environmental and lifestyle modifications may be implemented to improve DED [2]. Environmental adjustments include increasing indoor humidity levels and avoiding desiccating conditions that may exacerbate DED, such as air conditioning, Chronic [16] Tear substitutes targeting 1 or more layers of the tear film [2] Preserved solutions in patients requiring frequent dosing or using other chronic topical therapies [2] Safe for pediatric use [19] Refer to specific product information ...
... Short term (several weeks) [2,16] Anti-inflammatory and immunosuppressive effects mediated through multiple receptors [2] Ocular hypertension, cataracts, active infection [2] Use with caution in pediatric patients [19] No adverse neonatal outcomes observed [20] Lifitegrast (Xiidra V R ) Treatment of the signs and symptoms of DED [21] 12 weeks [21] Lymphocyte function-associated antigen-1 antagonist [21] Hypersensitivity to lifitegrast or any other ingredients in formulation [21] 17 years [21] No available data to inform drug-associated risk [21] Cyclosporine A Restasis V R Increase tear production in patients whose tear production is presumed to be suppressed due to ocular inflammation associated with DED [22] 6 months [22] Calcineurin inhibitor immunosuppressant [22] Hypersensitivity to any ingredients in formulation [22] 16 years [22] Maternal use not expected to cause fetal drug exposure [22] Cequa TM Increase tear production in patients with DED [23] 12 weeks [23] Calcineurin inhibitor immunosuppressant [23] None [23] 18 years [23] No adequately controlled studies to inform risk [23] Intranasal agents Varenicline (Tyrvaya TM ) Treatment of the signs and symptoms of DED [18] 4 weeks [18] Nicotinic acetylcholine receptor agonist [18] None [18] Adult [18] No available data to inform drug-associated risk [18] Systemic agents Antibiotics Azithromycin Treatment of blepharitis, MGD, and rosacea associated with DED [2] 5 days or pulse dosing for 1 month [2,24] Stimulator of meibomian gland function with antiinflammatory properties [2] Hypersensitivity, use with antipsychotics or other drugs that prolong the QTc interval, use with P-glycoprotein substrates, longterm use in HSCT recipients [25] Safe for pediatric use [26] Considered generally safe for use during pregnancy [27,28] Tetracyclines Treatment of chronic anterior blepharitis, MGD, and rosacea associated with DED [2] 4-10 weeks or chronic low dose [2] Broad-spectrum antibiotic with anti-inflammatory properties [2] Hypersensitivity, pregnancy or breastfeeding, children under 16 years old, use with penicillin or isotretinoin [24,29,30] 16 years [29] Use during pregnancy contraindicated [29,30] Supplements Omega fatty acids Inhibit proinflammatory cytokine production and T-lymphocyte proliferation implicated in DED [2] At least 3 months [2] Precursors of eicosanoids that modulate systemic inflammation [2] Liver disease, atrial fibrillation, bleeding disorders [2] Safe for pediatric use [31] Only pharmaceuticalgrade fish oil supplements safe for use during pregnancy [32] Antioxidants Prevent oxidative cellular injury that leads to ocular surface diseases like DED, improve ocular surface health [2,33] At least 1 month [2,33] Neutralize reactive oxygen species (free radicals) [33] May increase risk of certain cancers, cardiovascular disease, or diabetes; ...
... use controversial in patients on chemotherapy [34] Safe for pediatric use [35,36] Limited studies of safety during pregnancy [37] DED: dry eye disease; HSCT: hematopoietic stem cell transplant; MGD: meibomian gland dysfunction; QTc: corrected QT. Hypersensitivity to plug material, lacrimal pathway obstruction, ectropion, active ocular infection [42] Use with caution in pediatric patients [19,43] Meibomian gland thermal pulsation (Lipiflow V R ) Application of localized heat and pressure in adults with chronic cystic eyelid disorders including MGD (evaporative DED) [44,45] Yes [45] Every 3-12 months as needed [44] Applies heat to both inner eyelids to liquefy contents while pulsating pressure is simultaneously applied to outer eyelids to evacuate meibomian glands [44] Ocular surgery or injury within 3 months, ocular herpes within 3 months, active ocular infection or inflammation, history of recurrent ocular inflammation within 3 months, eyelid abnormalities affecting function, ocular surface abnormalities compromising corneal integrity [46] Adult [44] Intense pulsed light (OptiLight) Treatment of conditions such as MGD, rosacea, and telangiectasia, which may lead to DED [47,48] Yes [49] Every 4 weeks as needed [48] Photothermolysis: uses specific wavelengths from pulsed light source to destroy unwanted blood vessels by targeting their chromophores [47] Acute ocular inflammation [50] No studies evaluating efficacy or safety in children for treatment of MGD [51] Low-level light therapy (Epi-C Plus V R ) Treatment of MGD contributing to DED [52] Yes [38] Twice weekly for at least 1 month [53] Photobiomodulation: irradiation with nonionizing light to stimulate meibomian gland ATP production leading to endogenous healing and promoting meibum flow [52] Eyelid margin tattoos [52] No randomized clinical trials for treatment of MGD or DED [52] Microblepharoexfoliation open car windows, extended airline flights, or blowing fans [2,3]. Additionally, individuals frequently using computer stations should implement ergonomic adjustments such as lowering the screen, which allows a downward gaze that decreases exposure of the ocular surface to the air and reduces tear film evaporation [2]. ...
Article
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Dry eye disease (DED) is a multifactorial disorder characterized by loss of tear film homeostasis with an estimated worldwide prevalence of 5% to 50%. In DED, dysfunction of the ocular structures that create and regulate the tear film components—including the lacrimal glands, meibomian glands, cornea, and conjunctiva—causes a qualitative and/or quantitative tear deficiency with resultant tear film instability and hyperosmolarity. This initiates a vicious cycle of ocular surface inflammation and damage that may ultimately impair the quality of life and vision of affected patients. Many factors can contribute to the development of DED, including ocular and systemic diseases, topical and systemic medications, and environmental conditions. Because DED is a chronic disorder, treatment is most often long term and may utilize both pharmacologic and nonpharmacologic interventions to address all etiologic components. The long-term management of DED can be challenging and most often should involve eye care specialist referral. However, primary care clinicians (PCCs) are often the first points of contact for patients with DED and importantly provide initial diagnosis and preliminary patient education about the disease process. Consideration of DED is also vital for the practice of various specialties due to the large number of comorbidities and medications that can contribute to DED pathogenesis and progression. Therefore, it is important that PCCs and clinical specialists be aware of the etiology of DED and its available therapeutic options. This manuscript provides an overview of DED pathophysiology and treatment and discusses specific considerations regarding DED management for PCCs and clinical specialists. Key messages Successful management of dry eye disease often requires the use of various pharmacologic and/or nonpharmacologic therapies, as well as environmental and lifestyle modifications, to mitigate the underlying etiologies and restore tear film homeostasis. Primary care clinicians play an essential role in dry eye disease management by establishing a diagnosis, educating patients about the disorder, and providing referrals to eye care specialists for initiation of specialized treatment and long-term follow-up. Primary care clinicians and clinical specialists should consider prescribing medications with fewer ocular surface effects whenever possible in patients at risk for or with existing dry eye disease.
... The tendency of children to report fewer symptoms as compared to adults for a similar degree of ocular damage may also lead to underreporting or underdiagnosis of the problem [4]. Like other chronic diseases, the causes, visual morbidity and challenges in management of DED is very different in the pediatric age-group [5]. In fact, DED in children may be associated with a number of congenital, inflammatory, and autoimmune disorders, and it may also be influenced by environmental conditions and nutritional deficiencies [5]. ...
... Like other chronic diseases, the causes, visual morbidity and challenges in management of DED is very different in the pediatric age-group [5]. In fact, DED in children may be associated with a number of congenital, inflammatory, and autoimmune disorders, and it may also be influenced by environmental conditions and nutritional deficiencies [5]. The existing paucity of literature on DED in the pediatric population is a major concern and the need for expanding our knowledge on various aetiologies and clinical patterns of DED in this age group cannot be overemphasized. ...
... Children with ADDE, however, had more severe visual morbidity. In children with ADDE, thorough systemic evaluation to establish the underlying pathology like primary or secondary Sjogrens' syndrome and timely initiation of immunosuppression is vital not only to salvage vision, but also to control the multisystem involvement [5]. Dry eyes associated with cicatrizing conjunctivitis had the highest rates of developing blinding sequelae with SJS accounting for most of them. ...
Article
Purpose To describe the etiological causes and clinical profile of dry eye disease (DED) among children and adolescents seeking eye care in India. Methods This was a cross-sectional study of 1023 new patients (≤21 years of age) diagnosed with DED presenting between 2010 and 2018 to a multi-tier ophthalmology hospital network. Children and adolescents with both symptoms and signs of dry eyes were considered as subjects. The data entry and retrieval were done using an electronic medical record system and analyzed using appropriate statistical tests. Results The mean age of the patients was 15.2 ± 5.6 years and 76% were in their early and late adolescence. Overall, the main etiologies responsible for DED in children and adolescents were Meibomian gland dysfunction (MGD) in 49% of cases, Stevens-Johnson Syndrome (SJS) in 33% and Vitamin A deficiency (VAD) in 9%. Aqueous deficiency dry eye (ADDE) because of SJS and VAD accounted for most of the cases in infancy (92%), toddlerhood (96%), early childhood (76%) and middle childhood (68%). While Meibomian gland dysfunction (MGD) related evaporative dry eye (EDE) was the leading cause of DED in early (51%) and late adolescence (66%). Severe visual impairment and blindness was significantly greater in eyes with ADDE as compared to those with EDE (p < 0.0001), 81% of which were affected by SJS. Conclusion The causes of and visual morbidity due to DED varied significantly in different age-groups. Most of the visual morbidity in children and adolescents was limited to eyes with ADDE due to SJS.
... Although DED occurs in all age groups, it is least prevalent in children. There is a possibility that children may report fewer symptoms than adults for the same level of visual damage leading to underreporting and underdiagnosis of the disease [50]. The paediatric age group has a vast range of causes and treatments for DED. ...
... After dividing the data into different age groups, it was found that SJS and VAD were responsible for aqueous deficiency dry eye (ADDE) in 92% of infant patients, 96% of toddler patients, 76% of early childhood cases, and 68% of middle childhood cases. The main cause of DED in 51% of patients in early and 66% in late adolescence was MGD and evaporative dry eye [50]. The causes of optical impairment due to DED were found to be different in various age groups, with ADDE due to SJS being the most common among them. ...
Article
Full-text available
This short review focuses on the significance and prevalence of dry eye disease (DED) in the arena of ophthalmology. DED can be identified as one of the most common optical morbidities affecting about one-fourth of the patients visiting ophthalmology clinics. The perception of the cytology and disease evolution of DED has shown a noteworthy advancement in the last decade by recognizing two diverse mechanisms of the disease: tear desertion and deficient tear production. The role of these two components independently or concurrently in the prevalence of DED was also understood. Several studies in different parts of the world have projected that DED is more common in women as compared to men and this difference increases with ageing. Aged people, especially women in the menopausal and post-menopausal stages, are more prone to DED. This ailment is more prevalent in patients suffering from autoimmune diseases with a higher percentage of women getting affected. Various everyday activities as well as social and dietary behaviors like smoking might set off DED symptoms. Extensive visual tasking while using a computer, watching television, and doing a lot of reading also increase the risk of DED. Although DED occurs in all age groups, it is seen in very few children in comparison to adults. In fact, DED in children may be related to diverse factors such as congenial, inflammatory, and autoimmune disorders as well as environmental conditions and nutritional deficiencies. A significant relationship has also been found between DED and racial differences among individuals. A few studies have suggested that the Asian population is more susceptible to DED as compared to the Caucasian population, but this concept needs further research and investigation. Climatic conditions and environmental challenges, such as relative humidity (RH), internal atmosphere, effluence, travel by air, and intense temperatures, are equally important in the occurrence of DED. The present review aims to examine the prevalence of DED in relation to age, sex, and race by analyzing several relevant studies and also have an overview of the diagnosis and risk factors of the disease.
... 3 In pediatric population, dry eye disease is less prevalent and its epidemiology in children below the age of 18 years is very rare. 4 However dry eye signs and symptoms like excessive blinking or rubbing of eyes during study or watching television are observed in children, should be taken seriously as it may be a manifestation of several other disease conditions or causes. 5 Many cases of dry eye in children exhibited the presence of systemic conditions like Steven Jonson syndrome, Sjogren's syndrome, juvenile rheumatoid arthritis. ...
... 5 Many cases of dry eye in children exhibited the presence of systemic conditions like Steven Jonson syndrome, Sjogren's syndrome, juvenile rheumatoid arthritis. [4][5][6][7][8] In children dry eye may also be a result of increased visual tasking activity like overuse of computer and mobile phones for long duration as children tend to stare at the screen without eye blinking when they are using the computer or playing video games. [6][7][8] Use of video display terminals and learning (reading and writing) for a long hour has been associated with maximum blink interval, so there is development of dry eye symptoms. ...
Article
Full-text available
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 >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 >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. Keywords: Dry eye, Vernal kerato-conjunctivitis, Meibomian gland dysfunction, Visual display terminal
... 3 In pediatric population, dry eye disease is less prevalent and its epidemiology in children below the age of 18 years is very rare. 4 However dry eye signs and symptoms like excessive blinking or rubbing of eyes during study or watching television are observed in children, should be taken seriously as it may be a manifestation of several other disease conditions or causes. 5 Many cases of dry eye in children exhibited the presence of systemic conditions like Steven Jonson syndrome, Sjogren's syndrome, juvenile rheumatoid arthritis. ...
... 5 Many cases of dry eye in children exhibited the presence of systemic conditions like Steven Jonson syndrome, Sjogren's syndrome, juvenile rheumatoid arthritis. [4][5][6][7][8] In children dry eye may also be a result of increased visual tasking activity like overuse of computer and mobile phones for long duration as children tend to stare at the screen without eye blinking when they are using the computer or playing video games. [6][7][8] Use of video display terminals and learning (reading and writing) for a long hour has been associated with maximum blink interval, so there is development of dry eye symptoms. ...
Article
Full-text available
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 >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 >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.
... Other studies state that dry eye increases in old age and is rare in children because most of the factors involved in the pathophysiology of dry eye are more common in adults. [4][5][6] This fact affects the number of researches, concerning the prevalence and characteristics of dry eye in children, which are still very limited. Another fact is that the ability of children to express discomfort in ocular surfaces is lower than that in adults. ...
... 2 Whether the subject wears glasses or soft lenses on a daily basis. 3 Whether there is a history of allergies with hypo-allergenic drug therapy, 4 whether there is discomfort in the eyes with a verdict scale. 5 Duration of smartphone usage in a day. ...
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This study aims to investigate the association between prolonged use of smartphone and the incidence of dry eye among adolescents. A cross sectional study was performed among junior high school students in Makassar. Of 143 students within the age of 12–16 years old, 74 were those with over 3-h use of smartphone, while 69 spent less than or equal to 3 h. Ocular Surface Disease Index (OSDI) questionnaire was performed, followed by blink rate, Tear Break Up Time (TBUT), Tear Meniscus Height (TMH) examinations, and Schirmer test. Pearson's correlation, Independent-t and Chi Square tests were employed for data analysis. The result indicates that there was a significant association between the prolonged use of smartphone and dry eye incidence as specified by OSDI score (p < 0,01), abnormal blink rate (p < 0,01), TBUT (p < 0,05), TMH (p < 0,01), dan Schirmer test (p < 0,01). The more extent use of smartphone, the lower the scores of abnormal blink rate, TBUT, TMH, and Schirmer tests were obtained, and the higher OSDI score was gained. In conclusion, the prolonged use of smartphone promotes various eye disorders. Therefore, parental advisory upon the smartphone use among adolescents is necessary to prevent the detrimental effects.
... 4 In addition, various pediatric conditions (eg, congenital disorders and autoimmune/inflammatory diseases) have been associated with DED. 7 Overall, there is a paucity of data regarding DED in children; to the best of our knowledge, no such studies have been conducted in Latin America. The purpose of the current study was to describe ocular surface characteristics and ocular surface tests' results in a healthy pediatric population. ...
... Because we assessed normal pediatric population in Bogotá, it is essential to consider that this group is exposed to environmental factors (eg, pollution, ultraviolet radiation, and high altitude), which could affect the ocular surface. 33 These environmental factors, 7,34 the use of screen devices 6,7,17 and lid disorders 7 could lead to excessive air exposition, reduced blink frequency, eye closing alterations, and tear film instability, among others. All these have been closely related with evaporative dry eye disease. ...
Article
Full-text available
Purpose To describe ocular surface characteristics and tests’ results in a healthy pediatric population. Methods We performed a cross-sectional study with 60 healthy children, obtaining consent, OSDI and screen use survey and conducting ocular surface tests. Statistical univariate analysis for categorical and quantitative variables was made. To describe the correlation of the results in both eyes, we used a model of random effects. To characterize the possible profiles of device use, we applied the mixed-cluster methodology. Results Sixty healthy children between 7 and 17 years old were evaluated. Girl’s proportion was 41.6%. Mean Ocular Surface Disease Index Score was 9.98±8.49 points. Daily screen time was 5.59±2.77 hours and the most popular screen was the smartphone. Mean results (with standard deviations or confidence intervals) of ocular surface tests were blink frequency while reading on paper, 6.8±5.68 times per minute; blink frequency while reading on screen, 8.7±7.14 times per minute; tear meniscus height, 0.19[0.18–0.2] mm; non-invasive tear break-up time, 12.44[10.99–13.9] seconds; nasal conjunctival redness, 0.86[0.77–0.94]; temporal conjunctival redness, 0.96[0.87–1.04]; tear osmolarity, 299.3[295.14–303.45] mmol; and Schirmer test, 23.73[21.28–26.18] mm. Lid margin was irregular in three eyes; 44.7% had thin lipid layer; lissamine green staining was positive in 70.8%; fluorescein staining was positive in 47.4%; 36.64% exhibited partial meibomian gland loss. Conclusion Considering the scarcity of specific pediatric values of ocular surface tests, we performed a clinical investigation involving the complete pool of ocular surface tests in children. Although healthy children were included in this study, we found that all the participants had at least one abnormal result and 33.33% had dry eye disease diagnosis, according to the TFOS DEWS II. It would be relevant to carry out further multicentric studies to compare our ocular surface tests’ results with other groups of children.
... Wang et al [6] examined patients aged 12y in average visiting myopia clinic and found 18.95% were DED and prevalence was similar between boys and girls. Allergies may contribute to DED [7][8][9] and the results of recent investigations into DED in children have supported this theory [10][11] . The social impact of adolescent DED is now a concerning aspect of healthcare [12] . ...
... Our results were comparable with prior reports that the majority of healthy adolescents exhibited normal Schirmer test results [33] , even though many late adolescents with DED reported symptoms of dryness. Inflammation and allergy may be underlying factors in some cases of adolescent DED [6][7][8][9] . ...
Article
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Aim: To evaluate the signs and symptoms of dry eye disease (DED) in adolescents. Methods: This was a cross-sectional, case-control study and outpatients aged 10 to 19y were recruited from six eye clinics of various practices and locations in Japan, and 253 non-DED subjects and 70 DED patients were enrolled. Participants were examined for DED-related signs. Patients were also interviewed to ascertain the presence or absence of six common DED-related symptoms: dryness, irritation, pain, eye fatigue, blurring, and photophobia. Main outcome measures were differences in signs and symptoms of dry eye disease between boys and girls. Results: Of the 323 adolescents recruited, 70 (21.7%) were diagnosed with DED. Significant differences between the non-DED and DED groups were found for short tear break-up time (BUT; ≤5s;P=0.000) and superficial punctate keratopathy (SPK; staining score ≥3;P=0.000). Late adolescent girls reported fewer symptoms than late adolescent boys, although their DED-related signs were worse compared to other groups. The prevalence and severity of DED were similar in the Tokyo area compared with suburban and local areas but myopic errors were worse. Conclusion: We find that adolescents reported symptoms of DED similar to those found in adults, and the majority have short BUT-type DED. The prevalence and severity of DED in late adolescent girls is comparable with adults. Adolescents with DED are underserved and we believe that DED is a hidden but potentially serious health problem for this age group.
... La ESO en niños generalmente se trata con lubricantes oculares 83 ; si estas formulaciones tienen conservantes es probable que causen una acción citotóxica, lo que resulta muy dañino en los niños por lo que se recomienda el uso de FOLC en caso de tratamientos prolongados 84 . ...
Article
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Con el envejecimiento y ante el aumento de la expectativa de vida, las personas tienen más posibilidades de desarrollar patologías crónicas como glaucoma, ojo seco y cuadros de hipersensibilidad reactiva. Asimismo, estas patologías requieren de tratamientos oftálmicos tópicos a largo plazo que pueden tener conservantes. Los conservantes de las formulaciones oftálmicas cumplen la función principal de preservar el producto farmacológico y evitar su contaminación de forma tal que puedan utilizarse de manera segura hasta su fecha de vencimiento. La utilización de conservantes durante períodos cortos puede resultar beneficiosa, por ejemplo al facilitar aspectos farmacocinéticos de los antibióticos gracias a su potencial toxicidad epitelial. Pero en tratamientos prolongados se ha comprobado que los conservantes ocasionan toxicidad en la superficie ocular que depende de su concentración, su frecuencia de instilación y el tiempo total de uso. Esto se ha observado principalmente en el glaucoma y en la enfermedad de ojo seco, afectando la calidad de vida del paciente, el cumplimiento terapéutico y los resultados esperados. A su vez, también comienza a ser relevante ante el auge creciente del manejo farmacológico de la presbicia y la miopía (en población pediátrica) que en la mayoría de los casos tiende a ser prolongado. Por lo tanto, se están desarrollando nuevas opciones de conservantes más suaves y amigables con la superficie ocular, como también estrategias innovadoras para evitar completamente el uso de conservantes. En el este trabajo se ha revisado y actualizado el tema resaltando la importancia de considerar e identificar la presencia y/o variedad de conservantes en tratamientos prolongados.
... Despite deepening understanding of DED, the majority of current research is still based on adults, with limited knowledge of pediatric dry eye syndrome. Early detection in certain cases might lead to successful treatment and elimination of the root causes of DED [15]. There is limited literature on DED in the pediatric population, and given the increasing prevalence of dry eye disease in children and adolescents [16], there is a need to enhance our understanding of DED and pediatric ocular surface. ...
Article
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The study aimed to investigate the correlation between insulin-like growth factor 1 (IGF-1) and ocular surface parameters in obese prepubertal boys. Thirty obese prepubertal boys and 30 age- and gender-matched healthy controls underwent physical measurements, laboratory tests, and ocular surface assessments. The obese group showed lower IGF-1 levels (P = 0.001), reduced Schirmer I tear test (SIT) (P <0.001), and higher meibomian gland scores (meiboscore) compared to controls (P = 0.015). Bivariate analysis revealed a positive association between IGF-1 and SIT (r = 0.677, P < 0.001), and a negative association with between IGF-1 and meiboscore (r = − 0.487, P < 0.001). Multiple regression analysis indicated that IGF-1 (P < 0.001) and triglycerides (P = 0.028) independently influenced SIT. Logistic analysis showed a significant association between decreased IGF-1 and higher meiboscore values (OR 0.994, 95% confidence interval 0.988–1.000; P = 0.033). Conclusion: The findings suggest that reduced IGF-1 in obese prepubertal boys is independently linked to decreased SIT and increased meiboscore, irrespective of obesity and traditional cardiovascular risk factors. This implies that monitoring ocular surface parameters in obese children might provide a new perspective for clinical practice to focus on. What is Known: • Obese children exhibit decreased levels of IGF-1, and this reduction in IGF-1 is associated with cardiovascular metabolic complications related to obesity. • Ocular surface tissues might act as targets for hormones, might experience local effects of these hormone. What is New: • In prepubertal obese boys, the decrease in IGF-1 is independently linked to decreased SIT and increased meiboscore, irrespective of obesity and traditional cardiovascular risk factors.• This finding implies that monitoring ocular surface parameters in obese children might provide a new perspective for clinical practice to focus on.
... This could be explained by the corneal surface not being influenced only by internal conditions like uveitis but also by intermittent, episodic exposure to environmental stressors that lead to transient ocular signs. 21 Longitudinal studies that measure ocular surface signs at various points in patients with uveitis are necessary to understand better the permanent changes in the ocular surface secondary to uveitis. ...
Article
Purpose: This study aims to evaluate the ocular surface characteristics in children diagnosed with uveitis and explore the association between uveitis and dry eye disease (DED). Methods: We included 84 children, 42 with uveitis and 42 healthy children. We performed the OSDI questionnaire and several ocular surface tests, including osmolarity, NITBUT, Schirmer test, and vital staining. We used Fisher's exact test and Mann-Whitney to compare variables and a binomial logistic regression to determine the factors associated with DED. Results: The difference in the prevalence of DED between uveitis (54.8%) and healthy (31%) groups was statistically significant (p < 0.05). Most patients with uveitis had mixed DED, and none of the healthy subjects had a severe form of the disease. There were no statistically significant differences in most of the tear film tests. However, all parameters tended to worsen in the uveitis group, and lipid layer thickness was thinner (p < 0.036). The uveitis group exhibited significantly more symptoms (p < 0.05). In the multivariate logistic regression, uveitis was associated with an odds ratio (OR) of 3.0 (95% CI: 1.07-8.42, p < 0.05) for DED. Conclusions: Our findings demonstrate a significantly higher prevalence of DED in children with uveitis compared to their healthy counterparts. Furthermore, our analysis indicates that the risk of DED in pediatric patients with uveitis is threefold higher than in healthy children. Therefore, it is crucial for clinicians to vigilantly monitor the development of DED in pediatric patients with uveitis and consider the implementation of preventive treatments.
... [2][3][4][5] Children often do not complain of the foreign body sensation and burning associated with dry eyes; thus, the routine clinical tests for dry eye diagnosis are seldom performed. [1,6] Fluorescein tear-film break-up time (TBUT) and Schirmer's tests are invasive tests for dry eye evaluation and require children's cooperation. Ocular surface analysis (OSA), being non-invasive, may be used as an alternative tool for dry eye evaluation in pediatric patients. ...
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Purpose: To compare the motor and sensory outcomes of strabismus surgery and the factors affecting surgical success in acquired acute non-accomodative esotropia (ANAET) and partially accommodative refractive esotropia (pARET). Methods: A retrospective chart review of patients with ANAET and pARET who underwent unilateral or bilateral horizontal rectus muscle surgery between January 2020 and December 2021 was conducted. Patients with postoperative follow-up of at least six weeks were included. Patients with pattern deviation, lateral incomitance, and near-distance disparity were excluded. Motor success was defined as a postoperative deviation within eight prism diopters of orthophoria. Sensory success was defined as presence of binocular single vision (BSV) for both distance and near (Worth four dot test). The effect of factors like age at onset, age at surgery, amblyopia before surgery, duration of squint before treatment, presence or absence and magnitude of vertical deviation, preoperative angle of deviation, and spherical equivalent on the motor and sensory success in each group were analyzed and compared. Results: 38 patients with ANAET and 33 patients with pARET were included. The mean age of onset of esotropia was 8.55 ± 4.65 years and 4.39 ± 2.27 years (p < .001) and the mean age at surgery was 10.62 ± 4.99 years and 7.89 ± 2.84 years (p = .006) in the ANAET and the pARET group respectively. The mean duration of the final follow-up was 38.51 weeks in the ANAET and 48.68 weeks in the pARET group (p = .089). Patients were successfully aligned for both distance and near in 81.5% of patients in the ANAET and 78.9% of patients in the pARET group at the final follow-up (p. 0.775). A BSV for both distance and near at the final follow-up was seen in 81.2% vs 66.6% of patients in the ANAET and the pARET group respectively (p = .25). A good near stereoacuity (<120 arcsecs) was seen in 60.6% and 41.9% of the ANAET and the pARET groups respectively (p = .175). The percentage of patients in the ANAET group who had orthophoria, any esodeviation, and any exodeviation for distance at the final follow-up was 63.1%, 34.2% and, 2.6%. The percentage of patients in the pARET group in similar categories was 36.3%, 42.4% and, 21.2%. None of the demographic and preoperative factors were found to affect the surgical outcomes in the two groups. Conclusions: The motor and sensory outcomes were similar in the two groups. A higher proportion of ANAET patients remained orthophoric during the follow-up. The patients in the pARET group showed a tendency toward exodrift.
... About 25% of patients who come for eye check-up report with dry eye symptoms, making it a growing public health concern and one of the most common conditions seen by ophthalmologists. 1 Although, dry eye disease has usually been considered a disease of the elderly and the postmenopausal women, of late there has been a rise in patients presenting with dry eye symptoms in the paediatric age group. 2,3,4,5 Though, usually this condition in children is either overlooked or attributed to other causes of ocular irritation (allergies), recent studies have claimed an association of paediatric dry eye disease with the usage of video display terminal units. 6,7 Surveys conducted earlier have shown that there will be 15.6% smartphone users and annual rate of growth of smartphone users in India would be around 129%, even more than that of China (109%). ...
... [39] OSDI assessment may have limited benefit in detecting dry eyes in children due to poor compliance and difficulty in understanding instructions. [60][61][62] We could objectify the symptoms of dry eyes as a common feature of GO. Our study showed that GO children patients had a higher mean OSDI score (15.6 ± 18.7) compared with controls (5.67 ± 3.6). ...
Article
Purpose: 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. Methods: 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. Results: 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. Conclusion: 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.
... However, rare studies pay attention to the diagnosis and treatment of dry eye syndrome in children. While previous dry eye treatment options for children are similar to those for adults; the initial treatment consists of artificial tear eye drops and environmental recommendations (23). Owing to the popularization and widespread usage of OrthoK, it is urgent to improve the level of treatment of dry eye in children through OrthoK use. ...
Article
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Purpose This aim of this study was to evaluate the effect of 3% Diquafosol Ophthalmic Solution (DQS) on children with dry eye from wearing overnight orthokeratology (OrthoK) lenses. Methods Myopic children aged 8–18 years with dry eye syndrome were enrolled in this prospective observational study, and they were grouped according to their OrthoK treatment history for at least 1 year. All participants received DQS 4 times per day for 1 month. The following indicators were measured at baseline 1 month after treatment: the Dry Eye Questionnaire-5 (DEQ-5), non-invasive tear meniscus height (TMH), non-invasive tear film break-up time (first and average, NIBUT-F and NIBUT-A), meibomian gland score (MG score), conjunctival hyperemia redness score (R-scan), and blink pattern analysis. Results A total of 104 participants (189 eyes) including 40 OrthoK wearers (72 eyes) and 64 Orthok candidates (117 eyes) completed the study. Of all, after DQS treatment for 1 month, DEQ-5 scores reduced from 5.54 ± 3.25 to 3.85 ± 2.98 ( t = −3.36, p = 0.00). TMH increased from 0.20 ± 0.05 mm to 0.21 ± 0.05 mm ( t = 2.59, p = 0.01), NIBUT-F and NIBUT-A were prolonged from 6.67 ± 4.71 s to 10.32 ± 6.19 s and from 8.86 ± 5.25 s to 13.30 ± 6.03 s (all p = 0.00), respectively. R-scan decreased from 0.69 ± 0.28 to 0.50 ± 0.25 ( t = −9.01, p = 0.00). Upper MG scores decreased from 1.04 ± 0.32 to 0.97 ± 0.36 ( t = −2.14, p = 0.03). Lower MG scores, partial blink rate, partial blinks, and total blinks did not change significantly. Both break-up time (BUT) and R-scan improved significantly after DQS treatment for 1 month (all p = 0.00) in OrthoK candidates and OrthoK wearers. Among the OrthoK wearers, TMH and dry eye symptoms increased significantly (all p = 0.00) but did not increase in OrthoK candidates ( p > 0.05). There were no adverse events related to DQS. Conclusion Diquafosol Ophthalmic Solution was effective for children wearing overnight orthokeratology in relieving dry eye symptoms and improving ocular surface parameters, which may help improve children's OrthoK wearing tolerance and compliance.
... [2][3][4][5] Children often do not complain of the foreign body sensation and burning associated with dry eyes; thus, the routine clinical tests for dry eye diagnosis are seldom performed. [1,6] Fluorescein tear-film break-up time (TBUT) and Schirmer's tests are invasive tests for dry eye evaluation and require children's cooperation. Ocular surface analysis (OSA), being non-invasive, may be used as an alternative tool for dry eye evaluation in pediatric patients. ...
Article
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Purpose: To evaluate dry eyes in children with vernal kerato-conjunctivitis (VKC) and correlate it with symptoms, clinical findings, and ocular surface analysis (OSA) parameters. Methods: Children with clinically diagnosed VKC underwent complete ophthalmological examination, Schirmer's testing, modified ocular surface disease index (OSDI) scoring, Bonini grading, fluorescein tear-film break-up time (TBUT), VKC - Collaborative Longitudinal Evaluation of Keratoconus (CLEK) scoring, and OSA. Children with a TBUT of < 10 s were defined to have dry eyes. The above-mentioned parameters were compared between dry eye and non-dry eye VKC children. Results: The mean age of the 87 children included in the study was 9.1 ± 2.9 years. Dry eyes were seen in 60.9% [95% confidence interval (CI); 51% to 71%]. The mean TBUT was 13.4 ± 3.8 and 5.9 ± 1.9 s in non-dry and dry eye groups, respectively (P < 0.001). The mean value of Schirmer's test was 25.9 ± 9.8 and 20.8 ± 8.6 mm in the non-dry and dry eye groups, respectively (P = 0.01). The two groups did not differ in their OSDI scores, Bonini grading, and CLEK scores. The OSA parameter of non-invasive break-up time (NIBUT) was 8.3 ± 3.2 s in non-dry eye group and 6.4 ± 2.9 s in dry eye group, P = 0.008. The lower lid Meibomian gland (MG) loss was 7.4% in non-dry eye group and 12.2% in dry eye group, P = 0.028. Other OSA parameters did not differ significantly among the two groups. Conclusion: Dry eyes are seen in two-thirds of pediatric VKC. Evaluation of dry eyes should be incorporated in their clinical evaluation. Among OSA parameters, NIBUT and lower lid MG loss are associated with dry eyes in pediatric VKC patients.
... 21 Therefore, we highlighted that the prevalence of 'symptomatic DED' was 8.7% in elementary school children, which was similar to the findings of a Japanese report (6.7%) for elementary school children, 6 but lower than those reported in junior high school (16.4%), senior high school (21%-24%) and younger individuals below 20 years old (76.44%) in previous studies. 4 5 21 This finding suggests that the severity of DED symptoms increased with age in children and adolescents, which may be attributable to the increased usage of digital devices, as indicated in the TFOS DEWS II report. 2 Moreover, the presence of the ocular surface signs should not be overlooked as some young children may not be able to describe symptoms subjectively, 22 and considering the differences in ocular surface characteristics between Asians and Caucasians, the definition of 'definite DED' was devised based on symptoms and signs according to the consensus reported by the Asia Dry Eye Society. 12 Despite numerous studies reporting the prevalence of DED based on symptoms and signs in adults, due to the lack of a 'gold standard' for the DED diagnosis, each study used varying criteria and reported various prevalence rates (8.7%-30.1%). 2 A cross-sectional study published in 2017 among Shanghai University students reported a higher prevalence rate (10%) using the same DED definition. ...
Article
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Objective To investigate the ocular surface effects of different digital media experiences in Chinese elementary school students. Design Population-based cross-sectional study was used. Setting 14 randomly selected primary schools in Yuhuatai District, Nanjing, China Participants 2,694 students between 7 and 8-year-old. Outcome Measures Prevalence of and risk factors for different types of dry eye disease,and different digital media experience with different ocular signs. Results The prevalence of ‘symptomatic DED’ was 8.7% (95% CI 7.6% to 9.8%) and ‘definite DED’ prevalence rate was 5.5% (95% CI 4.7% to 6.4%). In multivariable logistic regression model, allergic conjunctivitis (OR=4.33, 95% CI (3.01 to 6.23), p<0.001), more than 1 hour per day on outdoor activity (OR=0.69, 95% CI (0.49 to 0.99), p=0.043), smartphone (OR=2.73, 95% CI (1.51 to 4.91), p=0.001), tablet (OR=2.09, 95% CI (1.07 to 4.07), p=0.030) and homework (OR=1.86, 95% CI (1.22 to 2.83), p=0.004) were independently associated with ‘definite DED’, while allergic conjunctivitis (OR=5.58, 95% CI (4.12 to 7.55), p<0.001), more than 1 hour per day on outdoor activity (OR=0.72, 95% CI (0.53 to 0.97), p=0.028), smartphone (OR=2.60, 95% CI (1.55 to 4.35), p<0.001), tablet (OR=1.84, 95% CI (1.02 to 3.34), p=0.044) and homework (OR=2.57, 95% CI (1.84 to 3.60), p<0.001) were independently associated with ‘symptomatic DED’. Conclusions Using smartphones or tablets for an average of more than 1 hour per day through the course of a year is independently associated with paediatric DED.
... In the current study, some children had a BUT less than 10 s before surgery, but dry eye was not diagnosed because they did not have any dry eye symptoms. In clinical practice, pediatric dry eye is often overlooked because of the child's inability to participate in the assessment of subjective symptoms [37]. Therefore, the BUT is a sensitive parameter for evaluating the ocular surface after pediatric strabismus surgery. ...
Article
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Introduction: This study aimed to investigate the incidence and risk factors for dry eye after pediatric strabismus surgery. Methods: Children aged 5-12 years who underwent strabismus surgery were included in this single-center, prospective, cohort study. The ocular surface assessments were conducted 1 day before and 1, 4, and 8 weeks after surgery. The main outcome measures were the incidence of dry eye after strabismus surgery and associated risk factors. Results: A total of 84 eyes (48 children) that underwent strabismus surgery were included in the study. The mean age at surgery was 7.21 years. The incidence of dry eye was 47.62% at 1 week, 10.71% at 4 weeks, 0% at 8 weeks after surgery. The preoperative tear breakup time (BUT) was lower in the dry eye group than that in the non-dry eye group (P ≤ 0.01). The univariate analysis showed that preoperative BUT was significantly associated with the incidence of dry eye after pediatric strabismus surgery (odds ratio [OR] 0.647, confidence interval [CI] 0.503-0.833, P ≤ 0.01). Conclusions: Dry eye commonly occurs after pediatric strabismus surgery. Tear film instability is more common than deficient aqueous tear production in patients with dry eye after surgery. Children with a low preoperative BUT are more likely to develop dry eye after strabismus surgery.
... 22,26 Although the use of artificial tears has demonstrated success in reducing symptoms of irritation or decreasing ocular surface dye staining in DED, there have been no clinical trials to evaluate the efficacy of single components of the ocular lubricants in a pediatric population. 27 This study included a group of pediatric patients with clinical diagnosis of allergic conjunctivitis and dry eye disease. We analyzed specific parameters such as TBUT, Schirmer's test score, conjunctival hyperemia and OSDI score at baseline and after four weeks of treatment. ...
Article
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Aim to assess the effectiveness of a new combination of topical solution with Hyaluronic Acid 0.2% and arnica extract 0.1% in reducing dry eye symptoms in a population of pediatric patients. Methods 52 pediatric patients (aged 9 to 14 years) with signs and symptoms of dry eyes and allergic conjunctivitis were included in the study. Twenty-six patients were assigned to the Hyaluronic Acid 0.2%/ Arnica extract 0.1% group (Study Group) while 26 patients to the Hyaluronic Acid 0.2% group (Control Group). Clinical signs and symptoms were assessed at baseline and at week 4. The assessment plan included: slit-lamp examination, tear film break up time (TBUT), Schirmer's test and conjunctival hyperemia score. Ocular surface disease index (OSDI) score was used to evaluate subjective symptoms of dry eye disease. Results Both treatment groups showed improvements in the estimated clinical parameters after treatment. OSDI score was significantly lower in both treatment groups (Study group p = 0.02; Control group p = 0.04) at the end of the follow up period. Improvements in TBUT, Schirmer's test results and conjunctival hyperemia were statistically significant only in the Study group (p = 0.021; p = 0.03; p < 0.01 respectively). Conclusions Preliminary findings suggest that combined topical Hyaluronic Acid 0.2% and arnica extract 0.1% can be effective in reducing symptoms and signs of dry eye disease in children.
... In children, keratitis sicca has been associated with congenital, autoimmune, endocrine and inflammatory disorders and certain environmental and nutritional conditions. 23 In this study, one in five patients with keratitis sicca were also diagnosed with systemic conditions. Other studies have shown that smartphone use in children is associated with paediatric dry eye disease, especially in older grade school students. ...
Article
Background/aims: To report the incidence and clinical characteristics of paediatric keratitis diagnosed over a 10-year period in a well-defined population. Design: Retrospective, population-based study. Methods: Setting: multicentre. Population: patients (<19 years) diagnosed with keratitis as residents of Olmsted County from 1 January 2000, through 31 December 2009. Main outcome measures: calculated annual age-specific and gender-specific incidence rates, demographic information and initial and final visual acuity. Results: A total of 294 diagnoses of keratitis occurred in 285 children during the 10-year period, yielding an incidence of 78.0 per 100 000 younger than 19 years (95% CI 69.0 to 87.1) or approximately 1 in 1282 children. The incidence increased throughout the 10-year study period (p<0.001). The mean age at diagnosis was 15.3 years (range, 0.2-18.9) and 172 (60.4%) were women. The observed forms included keratitis due to contact lens wear in 134 (45.6%), infectious keratitis in 72 (24.5%), keratitis not otherwise specified in 65 (22.1%) and keratitis sicca in 23 (7.8%). The visual acuity was reduced to ≤20/40 in 61 (21.4) of the 285 patients at the initial examination and in 24 (8.4%) at the final examination. Children with infectious keratitis had the poorest presenting vision and the best final vision, whereas the reverse was true for those with keratitis sicca. Conclusions: Keratitis, regardless of aetiology, was observed in approximately 1 in 1300 children by 19 years of age in this population-based cohort. Nearly half were related to contact lens wear and a decrease in vision to ≤ 20/40 occurred in 1 in 12 patients.
... As the first line of defense of the ocular surface, tear film is exposed to air and is particularly susceptible to air pollution [22,23]. DED was once considered a rare disease in children because of insufficient reporting of eye discomfort and a lack of cooperation during eye examinations among this vulnerable population [24]. However, in recent years, the prevalence of DED in children has rapidly increased worldwide [25,26], and more research is needed to evaluate this increase. ...
Article
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Objectives: This study aimed to investigate the associations between air pollution exposure and pediatric outpatient visits for dry eye disease (DED) in Shenzhen, China. Methods: Generalized additive models were utilized to explore the acute effects of air pollution exposure on pediatric outpatient visits for DED. Results: Single-day lag exposures to NO 2 , O 3 , PM 2.5 , and PM 10 were associated with DED outpatient visits at lag days 0, 6, 4 and 2. Relative risks (RRs) for DED given a 10-μg/m ³ increase in NO 2 , O 3 , PM 2.5 , and PM 10 concentrations were 1.062[95% confidence interval (CI) 1.003, 1.123], 1.015(95% CI 1.001, 1.031), 1.052(95% CI 1.001, 1.115), and 1.038 (95% CI 1.002, 1.076), respectively. RR for DED given a 10-μg/m ³ increase in NO 2 over cumulative lag days 0–1 was 1.075 (95% CI 1.009, 1.147), and RR for DED given a 10-μg/m ³ increase in PM 10 over cumulative lag days 0–4 was 1.051 (95% CI 1.003, 1.102). Conclusion: The observed associations between air pollution and outpatient visits for DED may provide evidence for policy makers to consider implementing measures to reduce the risk of DED owing to air pollution in China.
... Em qualquer caso a proteção ocular não deve substituir as estratégias que verdadeiramente reduzem a probabilidade de contrair a doença como são o distanciamento e o uso de máscara, métodos preventivos que demonstraram a sua eficácia numa meta--análise recente (Chu et al, 2020 (González-Méijome et al, 2007;Portello et al, 2013;Uchino et al, 2013). Segundo alguns autores, até é possível que afete os mais jovens muito antes de estes padecerem de alterações fisiológicas da lágrima tipicamente encontrada em idades mais avançadas (Alves et al, 2008). Um modo de compensar os efeitos adversos do trabalho intenso com computadores em períodos de teletrabalho e tele-estudo passa por incrementar a humidade relativa do ambiente (Wang et al, 2017) -Profissionais, utentes e a população em geral devem informar-se junto de fontes confiáveis, cientes de que em períodos críticos como os que vivemos irão proliferar notícias às quais não devemos dar credibilidade sem antes consultar as indicações das autoridades de saúde e os especialistas ao nosso alcance. ...
Chapter
Nesta obra reúnem-se cerca de meia centena de textos que retratam, a partir de diferente experiências, perspetivas e olhares disciplinares, a forma como a pandemia provocada pelo vírus SARS-CoV-2 foi sentida na Universidade do Minho, a primeira universidade portuguesa a ser atingida pelos seus efeitos, a partir de 7 de março de 2020. Os contributos aqui reunidos exprimem o modo como a comunidade académica se organizou para garantir o funcionamento da instituição e o cumprimento da sua missão, quer no âmbito do ensino, quer da investigação e da inovação, não dispensando uma necessária reflexão crítica sobre a nova realidade que se afirmou com a pandemia, o seu significado e os impactos da mesma na sociedade. Dado o elevado número e a diversidade dos contributos, a obra organiza-se em três volumes, que tentam dar resposta a três possíveis interrogações. Assim, o 1º volume, com o subtítulo de ‘Reflexões’, procura equacionar diferentes perspetivas em torno da questão: Mas o que é isto? Já o 2º volume, que recebe o subtítulo de ‘(Re)Ações’, corporiza um conjunto de textos que reflete as atuações em diferentes áreas da dimensão académica, elucidando quanto ao modo: Como reagimos? Finalmente, o 3º volume, que acusa o subtítulo de ‘Projeções’, dá expressão a uma inevitável pergunta: E agora? Pois, afinal, todos sabemos que isto não vai, nem pode, ficar tudo bem.
... In literature there are examples of dry eye disease secondary to other hormonal imbalance (e.g. ACTH-triple A syndrome, multiple endocrine deficiency) [106,110]. ...
Chapter
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The tear film is a thin fluid layer covering the ocular surface. It is responsible for ocular surface comfort, mechanical, environmental and immune protection, epithelial health and it forms smooth refractive surface for vision. The traditional description of the tear film divides it into three layers: lipid, aqueous and mucin. The role of each layer depends on the composition of it. Tear production, evaporation, absorption and drainage concur to dynamic balance of the tear film and leads to its integrity and stability. Nonetheless, this stability can be disturb in tear film layers deficiencies, defective spreading of the tear film, in some general diseases and during application of some general and/or topical medications. Dry eye disease is the result of it. In this review not only physiology of the tear film is presented. Moreover, we would like to discuss the influence of various diseases and conditions on the tear film and contrarily, spotlight tear film disorders as a manifestation of those diseases.
... The fourth conceivable effect of the ST increase is a growing frequency of dry eye disease, because long periods of focused ST may lead to incomplete eye blinking and therefore, may result in dry eyes [12][13][14]. It has been shown that using digital devices such as computers and televisions increased the frequency of dry eyes [15,16]. However, few studies have examined the relationship between ST and dry eye disease in children. ...
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Background: As internet use becomes more widespread, the screen time (ST) of elementary school students increases yearly. It is known that longer durations of ST can affect obesity, physical activity, dry eye disease, and learning ability. However, the effects of ST just before bedtime have not been clarified. Therefore, we examined ST duration and timing effects on elementary school children. Methods: We conducted a survey of 7,419 elementary school students in Tokyo, Japan using a questionnaire on food education. ST duration and timing (just before bedtime) served as the explanatory variables, and the relationship between obesity, physical activity, dry eyes, and learning ability was analyzed using logistic regression analysis. Gender, school year, height, and weight were considered confounding factors. First, we examined whether ST duration and timing were related to each objective variable, using a univariate model to examine all variables. Thereafter, we performed multivariate logistic regression analyses for all variables showing a significant difference in the univariate models. Results: The results showed that the relationship between the ST duration and obesity, physical activity, and learning ability was statistically significant. The relationship between ST timing and obesity, dry eyes, and learning ability was also statistically significant. Therefore, ST timing has a greater effect on dry eyes, and ST duration has a greater effect on academic performance. Conclusion: Our findings indicate that ST in school children is related to obesity, physical activity, dry eyes, and learning ability, and they suggest that not only the duration but also the timing of ST is important.
... About 25% of patients who come for eye check-up report with dry eye symptoms, making it a growing public health concern and one of the most common conditions seen by ophthalmologists. 1 Although, dry eye disease has usually been considered a disease of the elderly and the postmenopausal women, of late there has been a rise in patients presenting with dry eye symptoms in the paediatric age group. 2,3,4,5 Though, usually this condition in children is either overlooked or attributed to other causes of ocular irritation (allergies), recent studies have claimed an association of paediatric dry eye disease with the usage of video display terminal units. 6,7 Surveys conducted earlier have shown that there will be 15.6% smartphone users and annual rate of growth of smartphone users in India would be around 129%, even more than that of China (109%). ...
Article
Full-text available
Purpose To study the relationship between smartphone use and dry eye disease (DED) in pediatric age group. Materials & methods A prospective, quasi-experimental study of 78 children diagnosed with DED (as per International Dry Eye Workshop guidelines) was conducted at a tertiary care hospital, Odisha over the duration of 9 months from July 2016 - March 2017. Questions on time of smartphone/other visual display terminal use, continuous reading hour, outdoor activity were asked to older children and parents of younger children. Symptoms were noted and the Ocular Surface Disease Index (OSDI) score calculated. Ocular examination including slit lamp, inter blink interval (IBI), tear-film breakup time (TBUT) & Schirmer's test (ST) done. The patients were divided into Category A (continuous smartphone use for >/=1hr) & Category B (use for <1hr at a stretch/intermittent use). Results Of the 78 children (43.6% rural & 56.4% urban) 88.4% belonged to Category A and 11.6% to Category B. Mean IBI in Category A was 2.89s & in Category B it was 4.32s, mean TBUT was measured at 8.87 s and 9s in both the categories respectively, and a Schirmer's value of <10mm without anaesthesia in both the categories. Patients were reviewed again after discontinuing use of smartphone for 1 month. Improvement in symptoms and dry eye scores noted with the values being statistically significant (p<0.05). Conclusion Smartphone use continuously for longer time can lead to symptoms of DED in children. With increasing smartphone use among younger population this is a cause of concern.
... Similarly results were obtained by study by El Shazly et al. (7) Many risk factors are associated with pediatric dry eye which includes congenital, autoimmune, endocrine, and inflammatory disorders, or under certain environmental and nutritional conditions. (8) Body mass index was used as a surrogate marker for nutritional status in children. It not significantly associated with dry eye. ...
... One study reported OSDI scores implying that children with mild ocular surface damage report fewer dry eye symptoms compared with adults (19) . Assessment of OSDI may have limited benefit for detecting dry eye in children due to poor compliance and difficulty understanding the instructions (20,21) . ...
Article
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Purpose: We aimed to assess ocular surface characteristics in children with Hashimoto's thyroiditis without thyroid-associated ophthalmopathy and compare the results with those of healthy children. Methods: Twenty-two children with Hashimoto's thyroiditis (Group 1) and 20 healthy children without any ocular and/or systemic disorder (Group 2) were enrolled in the study. Ocular Surface Disease Index questionnaire, tear film osmolarity measurement (TearLab Osmolarity System, San Diego, CA, USA), Schirmer and tear film breakup time tests, meibography, and conjunctival brush cytology were performed and compared the results between the groups. Results: The study group included 19 girls and 3 boys in Group 1 and 12 girls and 8 boys in Group 2 (p=0.081). Thyroid-associated ophthalmopathy was not identified in any of the patients. Mean tear film osmolarity was 310.23 ± 11.98 mOsm/l in Group 1 and 313.60 ± 15.03 mOsm/l in Group 2 (p=0.424). Mean Schirmer test score was lower in Group 1 (14.91 ± 6.27) compared with Group 2 (23.60 ± 5.63) (p=0.001). Mean tear film breakup time was lower in Group 1 (11.78 ± 4.07) compared with Group 2 (15.1 ± 1.6) (p=0.013). Moreover, mean meibomian gland area loss was 25.01% ± 10.04% in Group 1 and 16.54% ± 6.02% in Group 2 (p=0.002). Conjunctival cytologic analysis in Group 1 revealed grade 0 changes in 6 patients (27.3%), grade 1 changes in 14 patients (63.6%), and grade 2 changes in 2 patients (9.1%), whereas 18 patients (90%) had grade 0 changes and 2 patients (10%) had grade 1 changes (p=0.001) in Group 2. Conclusions: The study demonstrates several ocular surface changes in children with Hashimoto's thyroiditis. These findings may indicate a tendency for dry eye in pediatric Hashimoto's thyroiditis patients without clinical evidence of thyroid-associated ophthalmopathy.
... Niektórzy uważają z kolei, że ogólnie syndrom suchego oka (zespół suchego oka, ZSO) występuje stosunkowo rzadko u dzieci [21]. Jednakże występowanie ZSO w najmłodszej populacji może być niedoszacowane, ponieważ stan ten może łatwo zostać przeoczony lub powiązany z innymi przyczynami, jak np. ...
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Komputery i inne urządzenia elektroniczne stały się codziennością większości ludzi na świecie. I choć kiedyś były używane tylko przez dorosłych, obecnie nawet malutkie dzieci po-trafią je świetnie obsługiwać. Nasuwa się zatem pytanie, czy generacja Z (osoby urodzone po 1996 roku) narażona jest na inne problemy niż ich pradziadkowie, którzy nie korzystali ze smartfona, laptopa, tabletu czy komputera? Czy w rozwoju technologii cyfrowych należy się dopatrywać tylko negatywnych efektów? A może stymulacja rozwoju niemowlęcia za po-mocą bajki oglądanej na tablecie czy smartfonie to świetny, uniwersalny zamiennik, a może nawet lepszy, dla przysłowiowej grzechotki? Może dzięki wykorzystaniu nowych technologii dzieci rozwijają się znacznie szybciej, a media społecznościowe zapewniają im niezbędny kontakt z rówieśnikami? Czy jako specjaliści powinniśmy się bać, czy raczej wspierać korzystanie przez dzieci i młodzież z nowych technologii? Spróbujmy zatem przyjrzeć się cyfrowemu światu dziecka i jego wpływowi na widzenie.
... Ocular surface disease such as dry eyes usually occurs in the presence of tear film dysfunction in combination with signs of other ocular surface structural changes and increased eye symptoms as reported in adults [5]. However, children are less likely to report less symptoms of ocular surface disease than adults [13][14][15][16]. Studies in adults have reported dry eye disease due to tear film dysfunction as the commonest ocular surface disease globally with a reported prevalence of 5-50% [12]. ...
Article
Purpose: A review of ocular surface and meta-analysis of tear stability (tear break up time, TBUT) and tear secretion (Schirmer test) values in healthy children was conducted. Methods: Articles published between 1996 and 2017 indexed on MEDLINE, PubMed, Embase, Scopus and Google scholar were retrieved using defined search terms. Statistical analysis (including sensitivity analysis and meta regression) was performed. Results: 23 studies were summarised (5291 neonates (0-29 days), infants (1 month-1 year) or children (1-18 years)) and a meta-analysis conducted using 15 eligible studies (1077 participants). The combined mean TBUT in children was 14.64 s (s) (95% CI, 11.64, 17.64) and 21.76 s (95% CI, 20.43, 23.09) for sodium fluorescein TBUT and non-invasive TBUT respectively (NIBUT). The combined mean NIBUT was 32.5 s (95% CI, 31.78-33.22) in neonates. The combined mean Schirmer I with and without anesthesia were 16.26 mm/5 min (95% CI, 13.17, 19.36) and 29.30 mm/5 min (95% CI, 27.65, 30.96) in children and 9.36 mm/5 min (95% CI, 6.54, 12.18) and 17.63 mm/5 min (95% CI, 12.03, 23.23) in neonates. Meta regression showed a significantly lower TBUT in children from studies conducted in Asia (p = 0.004). Conclusion: There is paucity of data on ocular surface variables in healthy children, making it difficult to draw valid comparisons with adult values.
Article
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.
Article
Background: Meibomian gland dysfunction (MGD) is the most common underlying cause of dry eye disease (DED). MGD leads to pathological alteration of the composition or quantity of meibum, or both, which subsequently results in tear evaporation and the typical signs and symptoms associated with DED. The LipiFlow Thermal Pulsation System (LipiFlow) is a medical device used to treat MGD in office; however, it is unclear if LipiFlow can outperform other DED treatments. Objectives: To evaluate the effectiveness of LipiFlow for treating DED signs and symptoms and the safety of LipiFlow compared with sham or other available treatments for MGD in adults. Search methods: The Cochrane Eyes and Vision Information Specialist searched the electronic databases for randomized controlled trials. There were no restrictions on language or date of publication. We searched the Cochrane Central Register of Controlled Trials (CENTRAL, including the Cochrane Eyes and Vision Trials Register; 2022, Issue 6), MEDLINE Ovid, Embase.com, PubMed, LILACS (Latin American and Caribbean Health Science Information database), ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) electronic databases. We also examined the reference lists of identified trials, review articles, and guidelines for information about relevant trials that may not have been identified by our search strategy. We contacted investigators regarding ongoing trials. The last database search was performed on 24 October 2022. Selection criteria: We included studies conducted in adults (over 18 years of age) with DED or MGD as defined by the primary trial investigators. We imposed no restrictions on race, ethnicity, or sex. We considered trials involving contact lens wearers if they were equally represented between groups. Data collection and analysis: We applied standard Cochrane methodology. Main results: We included 13 trials that randomized a total of 1155 participants (28 to 236 participants randomized per study). Six trials were conducted in the USA, three in China, two in Thailand, one in France, and one in Italy. Eight trials were of single-center design, while four trials were of multicenter design; one trial did not report the number of participating centers. Study characteristics The study population of the included trials was 66% female (range 48% to 80%), with an age range of 19 to 86 years. LipiFlow, used as a stand-alone intervention, was compared with basic warm compresses in five studies, thermostatic device in five studies, oral intervention in one trial, and topical dry eye medications in one trial. LipiFlow was also evaluated together with eyelid hygiene product versus eyelid hygiene products alone in one trial. Findings Five trials compared LipiFlow with a basic warm compress applied for varying durations and frequencies during the trial period; only one of these trials combined a warm compress with eyelid massage. Analyzing symptom scores by different questionnaires (Ocular Surface Disease Index [OSDI] and Standard Patient Evaluation of Eye Dryness [SPEED]) yielded conflicting evidence of a difference in symptoms between LipiFlow and basic warm compresses after four weeks. There was no evidence of a difference in meibomian gland expression, meibum quality, or tear breakup time when comparing LipiFlow with basic warm compresses. Another five trials compared LipiFlow with thermostatic devices. Analysis of symptom scores at four weeks showed that thermostatic devices had reduced OSDI scores by a mean difference (MD) of 4.59 (95% confidence interval [CI] 1.23 to 7.95; I2 = 0, P = 0.007; 553 participants; very low certainty evidence) as compared with LipiFlow. When we compared LipiFlow plus eyelid hygiene with eyelid hygiene alone, there was no evidence of difference in signs or symptoms at any time point evaluated. Only one trial compared LipiFlow with a topical DED medication (lifitegrast 5%). The single-trial estimate suggested that 5% lifitegrast may increase meibomian gland expression scores compared with LipiFlow at day 42 (MD -1.21, 95% CI -2.37 to -0.05; 50 participants; low certainty evidence) by using a meibomian gland expression scale of 0 to 8. One trial compared LipiFlow with an oral intervention (doxycycline), finding that LipiFlow may result in significantly better SPEED scores than doxycycline at three months (MD -4.00, 95% CI -7.33 to -0.67; 24 participants; very low certainty evidence). No other significant differences in signs or symptoms were found between LipiFlow and doxycycline at three months. We did not find any other statistically significant differences in symptoms or signs for any other analysis performed in this review at the one- to four-week time point. Adverse events No trial reported any intervention-related, vision-threatening adverse events. Authors' conclusions: LipiFlow performs similarly to other commonly used DED treatments with regard to DED signs and symptoms. The best available evidence was deemed to have a high level of bias, leading to low or very low certainty evidence. Additional research with adequate masking, a standardized testing methodology, and a sample representative of the MGD population is therefore needed before any firm conclusions can be drawn regarding comparative benefits and harms.
Article
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.
Chapter
Hematopoietic stem cell transplantation (HSCT) is commonly used as a curative therapy for both malignant and non-malignant pediatric hematological diseases. Despite development of better conditioning regimens, graft-versus-host disease (GVHD) is still a significant side effect of HSCT, leading to morbidity and mortality in affected children. GVHD primarily occurs in organs such as the skin, lungs, liver, gastrointestinal tract, mucosa, and eyes. Dry eye is the most common feature of chronic ocular GVHD and affected children can be either asymptomatic or present with foreign body sensation, redness, burning, or itching of eyes. Frequently ocular manifestations can precede other systemic findings. As an ophthalmologist, it is important to be aware of the systemic risk factors and manifestations of acute and chronic ocular GVHD. If left untreated, ocular GVHD can lead to corneal complications and vision loss in patients suffering from severe dry eye disease. Periodic ophthalmic examination in children who have undergone HSCT can result in early recognition of ocular GVHD in asymptomatic patients leading to prompt treatment and better prognosis.KeywordsOcular graft-versus-host diseaseGVHDHematopoietic stem cell transplantationHSCT complicationPediatric dry eye disease
Article
Introduction: While optical coherence tomography (OCT) measurements of the lower tear meniscus height (LTMH) have been reported in adults, here we obtained LTMH measurements through Fourier Domain OCT in healthy children and compared these with values obtained in healthy adults. Methods: Participants were children 7-17 years of age and a control group of adults 20-40 years of age. Inclusion criteria were no abnormal eye conditions or the use of contact lenses. Candidates who fulfilled the TFOS DEWS II criteria for dry eye disease (DED) were excluded. All subjects underwent LTMH measurement (OCT Spectralis) and tests for non-invasive tear break-up time and ocular surface staining. Participants also completed the ocular surface disease index questionnaire. Results: A total of 86 children and 27 adults were included. Mean LTMH values in the children and adult groups were 217.40 ± 71.40 μm and 225.0 ± 54.86 μm, respectively; p = 0.53. However, 59.3% of the children had an LTMH ≤210 μm suggestive of DED, compared with only 33.3% of adults (p = 0.02). For the children, no significant differences in LTMH were observed with sex or for those more or less than 12 years of age. Conclusions: Optical coherence tomography-derived LTMH measurements were obtained in healthy children. While values were similar in children and adults, a greater proportion of children had an LTMH compatible with a diagnosis of DED. More studies in different paediatric populations are required to establish a complete set of normative LTMH measurements.
Article
The aim of this study is to comprehensively evaluate the effect of smartphone use on the eye. Twenty-two children, aged 8-16 years, participated in this study. A self-administered questionnaire about smartphone usage time, outdoor activities, and sleep time to obtain dry eye was applied to the child and parents. An ocular surface disease index (OSDI), tear break-up time (TBUT), blink time, autorefractometer, optical biometry, accommodation, contrast sensitivity, and optical coherence tomography tests were applied before a 5-min video watching, and during the video session we counted the complete -incomplete blinks. After video watching, we did the tests. After the tests, we again applied a 5-min video watching and after the video we tested all the parameters again, and finally, following a 5-min resting period, we tested the parameters again. We found no difference between the groups in terms of OSDI scores. Children with punctate epithelial erosions and time spent on the phone have a statistical relation. TBUT also differs statistically before and after test periods ( p = .014), since complete blinks did not differ but incomplete blinks differed before and after video watching. The nearpoint of convergence also differs after video watching ( p = .008) and anterior chamber depth (ACD) decreases even after the short-time video watching period. On the contrary, we did not find any effect of short-time smartphone watching on auto-keratometer values and retinal-choroidal thickness. This is the first comprehensive study on the short-term effects of smartphone on the paediatric age group. Even 10 min of smartphone can have an effect on TBUT, incomplete blinks, nearpoint of convergence break-recovery, and ACD. During this coronavirus disease 2019 pandemic, we must be mindful of the time our children spend on the phone and keep in mind that even 10 min can have ocular effects.
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Pediatric graft-versus-host-disease (GVHD)-related dry eye disease (DED) is often overlooked due to a lack of subjective symptoms and reliable testing, leading to irreversible corneal damage. To study the clinical findings contributing to the accurate detection of pediatric GVHD-related DED, a retrospective study of pediatric patients treated with hematopoietic stem cell transplantation (HSCT) at Keio University Hospital between 2004 and 2017 was conducted. Association and diagnostic values of ophthalmological findings for DED were analyzed. Twenty-six patients who had no ocular complications before HSCT were included in the study. Eleven (42.3%) patients developed new-onset DED. The cotton thread test showed excellent diagnostic accuracy in detecting DED (area under the receiver operating curve, 0.96; sensitivity, 0.95; specificity, 0.85) with a cut-off of 17 mm, which was higher than the conventional threshold of 10 mm. Additionally, the presence of filamentary keratitis (FK) and pseudomembranous conjunctivitis (PC) were significantly associated with the diagnosis of DED (p value, 0.003 and 0.001 for FK and PC, respectively) and displayed good diagnostic performance (sensitivity, 0.46 and 0.54; specificity, 0.97 and 0.97 for FK and PC, respectively). In conclusion, the cotton thread test with a new threshold, the presence of PC and FK, could be helpful for promptly detecting pediatric GVHD-related DED.
Article
Background To investigate of the effect of vitamin D (Vit-D) deficiency on the tear film in children and compare it with that of healthy subjects. Methods This prospective and cross-sectional study comprised 75 eyes of children who had Vit-D deficiency (Group 1) and 85 eyes of age- and gender-matched healthy children (Group 2). The tear-film break-up time (TF-BUT) and Schirmer test values, as well as the Ocular Surface Disease Index (OSDI) scores, were recorded for the participants in all groups. Measurement of the tear meniscus area (TMA) and tear meniscus height (TMH) was performed 2 times in the same day via the use of anterior segment-optical coherence tomography (AS-OCT). Results The mean age of the participants in Group 1 was 12.42 ± 3.40 years, while in Group 2, it was 12.59 ± 2.32 years (p = 0.758). Group 1 comprised 43 females and 32 males, while Group 2 comprised 44 females and 41 males (p = 0.250). The mean TMH, TMA, and Schirmer test values were found to be significantly lower in children with Vit-D deficiency (Group 1) than in healthy children (Group 2), with p < 0.05 for all the values. It was concluded that there was no significant difference in the values for the mean TF-BUT and OSDI scores (p = 0.029 and p = 0.596, respectively). Conclusion The children with Vit-D deficiency exhibited lower TMH, TMA, and Schirmer test values. The alterations that were observed in these parameters were more prominent in the participants who had lower Vit-D levels.
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Purpose To evaluate ocular surface disorders in students whose daily screen time increased due to distance learning during the COVID-19 pandemic. Methods Eighty-eight eyes of 44 cases were included in this cross-sectional study. The distance learning students with complaints of redness, stinging, and increased blinking were evaluated. Biomicroscopic examination findings, spherical equivalent, keratometry values, and average daily average screen time were recorded. Ocular Surface Disease Index (OSDI) survey and non-contact tear film breakup time (BUT) assessment (Topcon CA-800) were performed. Results Forty-four cases between 15 and 25 years old were evaluated; 25 were girls (56.8%), 19 were boys (43.2%), and the mean age was 19.2 ± 3.9 years (15–25). The mean daily screen time was 4.9 ± 0.9 h. The mean non-contact BUT was 3.18 ± 2.0 s (1.24–8.80 s), and the spherical equivalent was -1.39 ± 1.79. Punctate epitheliopathy was present in 33 eyes (37.5%) on biomicroscopic examination. The mean OSDI score was 37.12 ± 20.30 (10–75) points. A significant positive correlation was present between daily average screen time, punctate epitheliopathy (r = 0,341; p = 0,001), and OSDI score (r = 0,510; p < 0,001). There was also a significant positive correlation between the OSDI score and punctate epitheliopathy (r = 0.754; p < 0.001). There was no significant correlation between the non-contact BUT and punctate epitheliopathy, OSDI score, or daily screen time (p > 0.05). Conclusion Ocular surface disorders in students can be associated with increasing daily screen time due to distance learning.
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Objective To analyze the incidence and risk factors of dry eye in children from a myopia outpatient clinic via a questionnaire and Keratograph 5M. Methods A 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. Results Thirty–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). Conclusion There 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.
Article
Purpose To determine if childhood obesity has an effect on the ocular surface and tear film of children who are afflicted. Methods Patients who had childhood obesity, 85 eyes, and patients who were healthy, 75 eyes, were enrolled in this prospective and comparative study. The tear film breakup time (TF-BUT), tear meniscus area and height (TMA and TMH) values, Schirmer test scores, and ocular surface disease index (OSDI) scores were obtained for all participants. Results The TMH, TMA, TF-BUT, and Schirmer test results were statistically significantly lower in the obesity group (p < 0.001 for all). The children with obesity and insulin resistance had lower TMH, TMA, TF-BUT, and Schirmer test results when compared to the children without insulin resistance (p < 0.05 for all). The body mass index was found to be correlated with the TMH, TMA, TF-BUT, and Schirmer test results (p < 0.001 for all). Conclusion Children with obesity had lower TMA, TMH, TF-BUT, and Schirmer test results than healthy subjects. When insulin resistance was added to obesity, these values were even lower.
Article
The congenital absence of tear production or alacrima is a distinctively unusual clinical sign that harbors a wide variety of etiologies. While alacrima can be only isolated to the lacrimal system, it is more often associated with progressive multisystem involvement from underlying genetic disorders. Recognizing the subtle ocular signs in these diseases will promote a timely diagnosis and management before potential life-threatening consequences occur. Hence, the current article will review the ophthalmological findings, systemic manifestations, genetic associations, and differential diagnosis of congenital alacrima.
Chapter
Since the advent of RET gene analysis in 1993, tremendous progress has been made in our understanding of the development of multiple endocrine neoplasia type 2 (MEN 2), an autosomal dominantly inherited endocrine syndrome. MEN 2 is subdivided into two clinical entities, both of which include distinct components that arise in an age-dependent manner and may not be present at the same time: MEN 2A, comprising medullary thyroid cancer, pheochromocytoma, and pseudonodular parathyroid hyperplasia, and MEN 2B, encompassing medullary thyroid cancer, pheochromocytoma, and various oral, ocular, intestinal, and “marfanoid” musculoskeletal manifestations. Deeper insight into the natural history of the disease has given rise to a paradigm shift in the operative management of MEN 2—from removal of target organs at the cost of greater morbidity to biochemical surveillance and targeted resection of adrenal tumors and hyperplastic parathyroid glands. The lead time afforded by early detection of asymptomatic MEN 2 carriers under biochemical monitoring defines a “window of opportunity” within which (1) mere total thyroidectomy is sufficient, avoiding morbidity inherent in central lymph node dissection; (2) subtotal “tissue-sparing” adrenalectomy is a viable approach in view of the well-manageable risk of secondary pheochromocytoma; and (3) parathyroidectomy can be restricted to enlarged glands considering the low risk of recurrent hyperparathyroidism in MEN 2A. The impressive advances in the management of MEN 2 accrued in the genomic era raise hopes that death and major morbidity from MEN 2 can be abolished in our lifetime.
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Eye care professionals first identified computer vision syndrome (CVS) more than 30 years ago, when computers emerged in the 1980s. CVS refers to the physical discomfort and vision-related problems experienced during and after prolonged computer use. These include eye fatigue, ocular discomfort, dry eye, blurred vision, tearing, headaches, neck pain and sensitivity to light. With the introduction and proliferation of smartphones, tablets, e-readers, laptops and other electronic devices in the past decade, CVS has increasingly been replaced by digital eye strain (DES) to describe the symptoms associated with the use of digital displays
Article
Purpose: To compare the symptoms and signs of dry eye disease (DED) in children with systemic lupus erythematosus (SLE) with those in healthy children using common diagnostic tools. Methods: Prospective, observational, single-center cohort study. Thirty-four subjects with SLE and 15 healthy subjects were recruited from the Hospital for Sick Children in Toronto, Canada. Subjects underwent subjective and objective dry eye assessments using the Canadian Dry Eye Assessment (CDEA) questionnaire, tear film osmolarity, slit lamp examination, tear film break-up time, corneal fluorescein staining, Schirmer test 1, and conjunctival lissamine green staining. Results: No difference in symptoms was found between children with SLE and healthy children (CDEA score 6.4 ± 5.4 vs. 3.8 ± 3.2; P = 0.09). Corneal staining was more prevalent in children with SLE than in healthy children (58.8% vs. 20.0%; P = 0.01), and children with SLE had higher mean corneal fluorescein staining scores (1.7 ± 1.7 vs. 0.2 ± 0.4; P = 0.002). No statistically significant differences in tear osmolarity, inter-eye differences in tear osmolarity, tear film break-up time, Schirmer test 1, or lissamine green staining scores were observed between the 2 groups. In healthy children, CDEA scores weakly correlated with corneal fluorescein staining score (r = 0.53, P = 0.04). In children with SLE, no correlation between CDEA score and any of the diagnostic test outcomes was found. Conclusions: There is discordance between symptoms and signs of DED in children with SLE. Corneal fluorescein staining is essential for the diagnosis of DED in these children.
Article
Purpose of review: To provide an overview of the pathogenic mechanisms underlying the correlation between ocular allergy and dry eye disease (DED), highlighting how the first condition may be a risk factor for the second one. Recent findings: Recent advances in our comprehension of the pathogenesis of ocular allergy and DED allow identifying several pathways of interaction between these two conditions. A growing body of evidence supports the role of ocular allergy as a risk factor for DED. Ocular allergy, particularly the severe forms of keratoconjunctivitis, can impact on different key mechanisms of the DED vicious cycle, including tear film instability, ocular surface inflammation and damage, and neurosensory abnormalities. Summary: Ocular allergy and DED are two common, relevant, symptomatic, not mutually exclusive conditions affecting the ocular surface. They share some clinical and biochemical features. To better understand the complex interactions between these two conditions, it's essential to consider the very wide spectrum of clinical conditions included in the term ocular allergy and the still largely unexplored peculiarities of the pediatric ocular surface physio-pathology and DED.
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OBJETIVO: Comparar achados diagnósticos de olho seco em crianças normais e com artrite reumatóide juvenil. MÉTODOS: Neste estudo transversal, 30 olhos de 15 pacientes com artrite reumatóide juvenil (grupo 1) e 22 olhos de 11 crianças-controle (grupo 2) foram examinados clinicamente e submetidos a testes para ceratoconjuntivite seca: Schirmer tipo 1, tempo de quebra do filme lacrimal e coloração com rosa bengala. RESULTADOS: Seis crianças com artrite reumatóide juvenil apresentaram um ou mais sintomas de ceratoconjuntivite seca (40%) e cinco destas (83,3%) mostravam meibomite ou outros sinais dessa afecção. Nenhuma criança do grupo 2 apresentou sinais ou sintomas de ceratoconjuntivite seca. No teste de Schirmer não se observou diferença significativa entre os grupos 1 e 2 (p=0,156). Entretanto, o tempo de quebra do filme lacrimal foi significativamente menor no grupo 1 (p=0,0005) e de maneira semelhante, o escore do teste de rosa bengala foi significativamente maior no grupo 1 (p=0,0038). Cinco das 15 crianças estudadas do grupo 1 apresentaram um ou mais testes alterados e tiveram diagnóstico definitivo de ceratoconjuntivite seca, ao passo que quatro (26%) tiveram o diagnóstico de provável ceratoconjuntivite seca. No grupo 2, nenhuma criança apresentou mais de um teste positivo. CONCLUSÕES: Sinais e sintomas de ceratoconjuntivite seca constituem achados comuns em crianças com artrite reumatóide juvenil. Embora apenas o tempo de quebra do filme lacrimal e a marcação com rosa bengala tenham tido diferença significativa entre os grupos, parece haver tendência a resultados piores nos testes de olho seco realizados em crianças com artrite reumatóide juvenil.
Article
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OBJETIVO: Comparar achados diagnósticos de olho seco em crianças normais e com artrite reumatóide juvenil. MÉTODOS: Neste estudo transversal, 30 olhos de 15 pacientes com artrite reumatóide juvenil (grupo 1) e 22 olhos de 11 crianças-controle (grupo 2) foram examinados clinicamente e submetidos a testes para ceratoconjuntivite seca: Schirmer tipo 1, tempo de quebra do filme lacrimal e coloração com rosa bengala. RESULTADOS: Seis crianças com artrite reumatóide juvenil apresentaram um ou mais sintomas de ceratoconjuntivite seca (40%) e cinco destas (83,3%) mostravam meibomite ou outros sinais dessa afecção. Nenhuma criança do grupo 2 apresentou sinais ou sintomas de ceratoconjuntivite seca. No teste de Schirmer não se observou diferença significativa entre os grupos 1 e 2 (p=0,156). Entretanto, o tempo de quebra do filme lacrimal foi significativamente menor no grupo 1 (p=0,0005) e de maneira semelhante, o escore do teste de rosa bengala foi significativamente maior no grupo 1 (p=0,0038). Cinco das 15 crianças estudadas do grupo 1 apresentaram um ou mais testes alterados e tiveram diagnóstico definitivo de ceratoconjuntivite seca, ao passo que quatro (26%) tiveram o diagnóstico de provável ceratoconjuntivite seca. No grupo 2, nenhuma criança apresentou mais de um teste positivo. CONCLUSÕES: Sinais e sintomas de ceratoconjuntivite seca constituem achados comuns em crianças com artrite reumatóide juvenil. Embora apenas o tempo de quebra do filme lacrimal e a marcação com rosa bengala tenham tido diferença significativa entre os grupos, parece haver tendência a resultados piores nos testes de olho seco realizados em crianças com artrite reumatóide juvenil. Descritores: Artrite reumatóide juvenil/diagnóstico; Ceratoconjuntivite seca/diagnóstico; Técnicas de diagnóstico oftalmológico; Lágrimas/análise; Rosa bengala/uso diagnóstico; Criança; Estudo comparativo
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In recent years attention has been paid to meibomian gland dysfunction (MGD) as a distinct clinical entity responsible for chronic symptoms and signs and occurring independently or in association with atopy, cicatrising mucosal disorders and rosacea. Attempts to correlate MGD with microbiological and lipid biochemical changes are confounded by the absence of a clear descriptive language for the disorder and its associated changes. Such a language is crucial for the conduct of cross-sectional and natural history studies and therapeutic clinical trials. We present a comprehensive classification and grading scheme of meibomian gland disease, supporting our observations with illustrations.
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Forty three patients with cystic fibrosis, aged 8-44 years (median 16 years), were examined for evidence of vitamin A deficiency. Eight patients had abnormal dark adaptation tests and three had conjunctival xerosis. Serum vitamin A and retinol binding protein concentrations were significantly lower in the affected patients who were also more likely to have abnormal liver function tests. Five patients were treated with 100,000-200,000 IU water miscible vitamin A orally and their daily vitamin supplements were increased to maintain normal concentrations. In four patients dark adaptation tests were repeated. Three were normal, but one patient required three further doses of water miscible vitamin A and a daily supplement of 12,000 IU vitamin A before her dark adaptation threshold returned to normal. Adolescents with cystic fibrosis are liable to develop night blindness and conjunctival xerosis, particularly if they have liver disease or fail to take daily vitamin supplements.
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Differential diagnosis of allergic conjunctivitis or dry eye is sometimes very difficult to diagnose by symptoms and clinical examination alone, especially in older patients. It was hypothesised that clinically allergic patients who were serum antigen specific IgE negative were candidates for dry eye. Sixty patients were studied prospectively who were clinically diagnosed with allergic conjunctivitis by their itchy sensation and papilla formation of conjunctiva. They consisted of 30 serum antigen specific IgE positive and 30 IgE negative patients, with no significant differences in age. Dry eye examination and serum total IgE were performed on these two groups. No significant differences were seen between the two groups with regard to age (p = 0.76) and sex ratio. The antibody negative group had lower Schirmer's test scores (p = 0.002), lower tear clearance (p = 0.0001), lower tear function index (p = 0.0001), and lower serum total IgE (p = 0.04) than the antibody positive group. This study suggests that the evaluation of serum antigen specific IgE and tear dynamics are important for the differential diagnosis of patients with allergic conjunctivitis and dry eye. Clinically diagnosed allergic conjunctivitis with negative serum antigen specific and total IgE can be one form of dry eye.
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The objective of this study was to assess the ocular complications and visual loss among patients with severe vernal keratoconjunctivitis (VKC). A total of 58 consecutive patients (52 boys and 6 girls aged 8 to 17 [mean 12.2] years) with severe active VKC were examined at two tertiary care facilities in Riyadh, Saudi Arabia, between 1995 and 1997. Patients were deemed to have severe VKC if they had had symptoms for at least 2 years, had diffuse palpebral conjunctival edema and thickening with papillary hypertrophy (P3) and giant papillary conjunctivitis, and had limbal infiltration of 180 degrees or more. Visual acuity was measured with the standard Snellen visual acuity chart. Visual impairment was assessed by means of the World Health Organization criteria for visual disabilities. Visual loss was defined as either blindness or visual impairment. Twelve patients (21%) had a best corrected visual acuity in one or both eyes of 20/200 or less, 20 (34%) had 20/50 to 20/200 vision, and 26 (45%) had 20/20 to 20/50 vision. The ocular complications that led to visual loss among 32 patients included steroid-induced cataract (8 patients), steroid-induced glaucoma (4), central corneal scars (7), irregular astigmatism (4), keratoconus (3) and limbal tissue hyperplasia (3). Of the 32 patients 12 had dry eye syndrome, which may have contributed to the visual loss. Severe VKC in developing countries is a potentially blinding disease. Visual loss may be due to corneal complications, including corneal scars, astigmatism and keratoconus, as well as complications of the unsupervised use of topically administered corticosteroids.
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To describe the ophthalmic findings in a large cohort of epidermolysis bullosa (EB) patients managed in one large specialist centre. A case note review of consecutive patients seen at Great Ormond Street Children's Hospital. Data on the dermatological disease, ophthalmic history, and examination were collected and coded onto a data sheet. 181 patients: 50 (28%) simplex EB; 15 (8%) junctional EB; 28 (15%) autosomal dominant dystrophic EB; 72 (40%) autosomal recessive dystrophic EB; nine patients (5%) with dystrophic EB whose inheritance could not be ascertained; and seven cases (4%) of EB that could not be classified. Ocular problems were found in 12% (n = 6) of simplex patients and 40% (n = 6) of those with junctional disease. One patient (of 28) in the autosomal dominant dystrophic group had ocular involvement and 51% (37/72) of patients in the autosomal recessive dystrophic group had ophthalmic complications: corneal (25/72), lid ectropions (3/72), lid blisters (5/72), and symblepharon (3/72). Ophthalmic complications are common in EB overall but the incidence varies widely with subtype. Ophthalmic complications are the most severe in the dystrophic recessive and junctional subtypes where there is a need for extra vigilance. The major treatment modality was use of ocular lubricants.
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This study aimed at revisiting vernal keratoconjunctivitis (VKC) on the basis of anamnestic, clinical, immunologic, histopathologic, and followup data of 195 patients. Retrospective noncomparative case series. One hundred and ninety-five patients with VKC. Clinical evaluation and outcome in 151 of 195 patients with a median followup of 47 months. Evaluation was by telephone survey in 69 patients. (1) Demographic, clinical, and immunologic features of VKC and their influence on the course of the disease; (2) conjunctival and corneal complications and efficacy of treatment observed during the followup period. VKC is a chronic disease. More than 60% of patients had repeated recurrences all year round. Males had an earlier presentation of symptoms than females and the male/female ratio decreased with age. Major (greater than 80%) and minor (up to 80%) diagnostic criteria were defined for clinical signs and symptoms of the disease. Negative skin test or radioallergosorbent test was present in approximately 50% of patients, whereas eosinophil infiltration was a constant histopathologic finding. A marked conjunctival sensitivity to nonspecific stimuli was noted in more than one third of patients. In 6% of cases, a reduction of visual acuity resulted from corneal scarring, and in 2% of patients, steroid-induced glaucoma was observed. The large size of giant papillae indicates poor prognosis for the persistence of the disease and its evolution into a chronic, perennial condition. VKC is a chronic eosinophilic disease of the ocular surface involving IgE, non IgE-mediated mechanisms, and age-sex-related influences. Although the disease has a good prognosis, severe visual impairments may result from long-standing inflammation.
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Toxic epidermal necrolysis (TEN) is an acute inflammatory systemic condition that involves injury not just to the skin. Historically, it has been associated with a high mortality but few long-term consequences among survivors. With improved survival, long-term consequences may be becoming more apparent. The objective of this study was to define these long-term consequences and their frequency. From July 1, 1991, to June 30, 2000, 11 children with severe TEN were referred to a regional pediatric burn facility. Wounds were managed with a strategy involving prevention of wound desiccation and superinfection, including the frequent use of biological wound coverings. All children survived and have been followed in the burn clinic. The records of all children were reviewed in detail. Two boys and 9 girls with an average age of 7.2 +/- 1.8 years (range: 6 months-15 years) and sloughed surface area of 76 +/- 6% of the body surface (range: 50%-95%) were admitted to the burn unit for care. Antibiotics (3 children), anticonvulsants (4 children), nonsteroidals (2 children), and viral syndrome or unknown agents (2 children) were believed to have triggered the syndrome. Six (55%) children required intubation for an average of 9.7 +/- 1.8 days (range: 2-14 days). Mucosal involvement occurred in 10 (91%) and ocular involvement in 10 (91%). Lengths of stay averaged 19 +/- 3 days (range: 6-40 days). Overall follow-up averaged 14 +/- 13 months. Three children had no apparent long-term consequences of the disease and were referred to primary care follow-up after the 2-month burn clinic visit. The remaining children had follow-up averaging 23 +/- 13 months. The most common long-term morbidity involved eyes (3 children [27%]), nails (4 children [36%]), and variegated skin depigmentation (all children). One child developed vaginal stenosis from mucosal inflammation. No esophageal strictures or recurrent TEN has been diagnosed. Survival has improved in children with TEN, but long-term sequelae are not infrequent. The most common long-term consequences involve the eyes, the skin, and the nails.
Conference Paper
The report of the Epidemiology Subcommittee of the 2007 Dry Eye WorkShop summarizes current knowledge on the epidemiology of dry eye disease, providing prevalence and incidence data from various populations. It stresses the need to expand epidemiological studies to additional geographic regions, to incorporate multiple races and ethnicities in future studies, and to build a consensus on dry eye diagnostic criteria for epidemiological studies. Recommendations are made regarding several characteristics of dry eye questionnaires that might be suitable for use in epidemiological studies and randomized controlled clinical trials. Risk factors for dry eye and morbidity of the disease are identified, and the impact of dry eye disease on quality of life and visual function are outlined. Suggestions are made for further prospective research that would lead to improvement of both eye and general public health.
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Triple A (Allgrove) syndrome is characterized by achalasia, alacrima, adrenal abnormalities and a progressive neurological syndrome. Affected individuals have between two and four of these relatively common clinical problems; hence the diagnosis is often difficult in all but the classical presentation. The inheritance is autosomal recessive, and most cases of triple A have no family history. Using genetic linkage analysis in a small number of families, a locus on chromosome 12q13 was identified. The triple A gene was identified recently at this locus and called ALADIN (alacrima, achalasia, adrenal insufficiency neurologic disorder). Mutations in this gene were reported in families from North Africa and Europe. The majority of mutations were homozygous. We have identified 20 families with between two and four of the clinical features associated with the triple A syndrome. Sequencing of the triple A gene revealed five families that had a total of nine compound heterozygous mutations, and one Portuguese family (previously published) had two homozygous mutations; these changes were spread throughout the triple A gene in exons 1, 2, 7, 8, 10, 11, 12, 13 and 16, and the poly(A) tract. Those bearing mutations had the classical triple A syndrome of achalasia, alacrima, adrenal abnormalities and a progressive neurological syndrome. We identified a spectrum of associated neurological abnormalities in these cases, including pupil and cranial nerve abnormalities, frequent optic atrophy, autonomic neuropathy and upper and lower motor neurone signs including distal motor neuropathy and amyotrophy with severe selective ulnar nerve involvement. In these families, we have made genotype–phenotype correlations. Mutations in the triple A gene are thus an important cause of this clinically heterogeneous syndrome, and sequencing represents an important diagnostic investigation. Identifying further mutations and defining their phenotype along with functional protein analysis will help to characterize this neuroendocrine gene.
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Background Although term and preterm infants have the capacity to secrete tears, the relative contribution of basal and reflex secretion of tears has not been previously assessed together in a prospective study. This information potentially has practical clinical importance.Objectives To measure basal and reflex tear secretion in preterm (30-37 weeks after conception) and term (38-42 weeks) newborns and to determine the developmental pattern of tear production.Methods Tear secretion was evaluated by applying Schirmer tear test strips to the inferior fornix for 5 minutes before (reflex plus basal secretion) and after (basal secretion) applying a topical anesthetic agent.Results Seventy infants (36 preterm and 34 term) were tested. Mean (± SD) basal tear secretion was 6.2 (± 4.5) mm in preterm and 9.2 (± 4.3) mm in term infants and increased progressively with increasing weight (P<.001) for all newborns. Mean (± SD) reflex tear secretion was 7.4 (± 4.8) mm in preterm and 13.2 (± 6.5) mm in term infants and also increased with increasing weight (P<.001) for all newborns.Conclusions Preterm infants have reduced reflex and basal tear secretion. This may mask the diagnosis of a nasolacrimal duct obstruction, concentrate topically applied medications, and allow corneas to quickly become dry during ophthalmological examination and treatment. By term, tear production in newborns is similar to that in adults.
Article
Purpose: To describe tear function, mucin alterations, and ocular surface disorder in patients with atopic diseases. Methods: Subjects underwent corneal sensitivity measurements, Schirmer test, tear film break-up time (BUT) assay, and fluorescein and rose Bengal staining of the ocular surface. Conjunctival impression cytology and brush cytology were also conducted. Impression cytology samples underwent PAS and immunohistochemical staining for MUC5AC. Brush cytology specimens underwent evaluation for inflammatory cell expression and RT-PCR for MUC5AC mRNA expression. Differences related to tear function and ocular surface examination parameters among patients with and without corneal ulceration and healthy control subjects were studied. Results: Mean corneal sensitivity and BUT values were significantly lower in atopic patients with corneal ulcers compared with patients without ulcers and controls (P < 0.001). Brush cytology specimens from patients with corneal ulcers revealed significantly higher expression of inflammatory cells compared with patients without ulcers and controls (P < 0.001). Impression cytology samples from eyes with corneal ulcers showed significant squamous metaplasia and reduction of goblet cell density compared with eyes without ulcers and control subjects. Specimens from eyes with corneal ulcers showed PAS (+) mucin pick up and did not stain positive for MUC5AC. MUC5AC mRNA expression was significantly lower in eyes with corneal ulcers compared with in eyes without ulcers and control subjects. Conclusions: Ocular surface inflammation, tear film instability, and decreased conjunctival MUC5AC mRNA expression are important in the pathogenesis of noninfectious corneal shield ulcers in atopic ocular surface disease.
Article
Objective: This study aimed at revisiting vernal keratoconjunctivitis (VKC) on the basis of anamnestic, clinical, immunologic, histopathologic, and followup data of 195 patients.
Article
To investigate the ocular complications in pediatric bone marrow transplantation (BMT) patients. Cross-sectional study. A total of 29 pediatric BMT patients were studied. Comprehensive ophthalmic check-up, including best-corrected visual acuity, intraocular pressure (IOP), Schirmer's test, tear breakup time, and slit-lamp and fundus examinations, was performed. Tear film instability and its related complications, IOP, cataract, and fundus lesions were measured. The mean age of patients was 9.1 years (range, 1.5-15 years). The mean post-BMT duration was 20.2 months (range, 3-54 months). Fifteen patients (51.7%) had tear abnormalities. Subconjunctival fibrosis was detected in two patients (6.9%). Dry and scaly skin of the eyelids was seen in one patient (3.4%). Lens opacities were found in 2 (33.3%) of 6 irradiated patients and 2 (8.7%) of 23 nonirradiated patients. Two patients (6.9%) had fundus changes, one with unilateral epiretinal membrane and the other with bilateral multiple discrete chorioretinal hypopigmented lesions in the middle to peripheral part of the retina. The overall complication rates for the anterior and posterior segments were 75.8% and 6.9%, respectively. Ocular manifestations of BMT in children are not uncommon. The most common anterior segment problem is tear dysfunction. Posterior segment complications are less common but do exist. High rate of cataract formation is reported, and this probably is the most important long-term "amblyogenic" problem in these immature eyes. Awareness and management of these problems with routine eye examination and early intervention are recommended.
Article
Sjögren’s syndrome is uncommon in children, and occurs most often in association with autoimmune diseases (secondary Sjögren’s syndrome). We describe the clinical and biological features of a 13-year-old girl with primary Sjögren’s syndrome, revealed by recurrent parotitis.Case report. – This adolescent girl was referred for investigation of multiple episodes of bilateral parotid swelling since age nine, without systemic symptoms. Examination was unremarkable except for enlarged and painless parotid glands. Laboratory investigations, measurement of saliva production, parotid sialography, labial salivary gland biopsy, revealed Sjögren’s syndrome without associated disease. Hydroxychloroquine was prescribed with clinical improvement.Conclusion. – Recurrent parotitis in children is an uncommon condition. The onset of parotid swelling at five years or over deserves screening for dysimmune disorders, sarcoidosis or Sjögren’s syndrome. Diagnosis of Sjögren’s syndrome is based on laboratory evidence of autoimmune disorders and minor salivary gland biopsy.
Article
The aim of the DEWs Definition and Classification Subcommittee was to provide a contemporary definition of dry eye disease, supported within a comprehensive classification framework. A new definition of dry eye was developed to reflect current understanding of the disease, and the committee recommended a three-part classification system. The first part is etiopathogenic and illustrates the multiple causes of dry eye. The second is mechanistic and shows how each cause of dry eye may act through a common pathway. It is stressed that any form of dry eye can interact with and exacerbate other forms of dry eye, as part of a vicious circle. Finally, a scheme is presented, based on the severity of the dry eye disease, which is expected to provide a rational basis for therapy. these guidelines are not intended to override the clinical assessment and judgment of an expert clinician in individual cases, but they should prove helpful in the conduct of clinical practice and research.
Article
Sjögren’s syndrome is a chronic inflammatory systemic autoimmune disease mainly affecting the exocrine and, particularly, the salivary and lacrimal glands. The condition usually occurs in adults. In 1994, the criteria for this syndrome were redefined in a multicenter European study. In children, Sjögren’s syndrome is a rare and probably underdiagnosed disease. To date, Sjögren’s syndrome in children has only been described in case reports and in the comparative presentation of various study results. So far, no study of a comparative classification into primary and secondary Sjögren’s syndrome has been carried out in a patient population of any size. Sjögren’s syndrome should be considered in the differential diagnosis of children with recurrent parotitis, keratoconjunctivitis sicca, or pronounced and early tooth decay associated with xerostomia. In this study of 23 children and adolescents under the age of 16 with the clinical symptoms and laboratory findings of Sjögren’s syndrome, we differentiate between primary and secondary Sjögren’s syndrome. The value of the individual methods of assessing the oral and the ophthalmological components and the manifestation of the underlying rheumatic condition are discussed on the basis of the EULAR criteria. The EULAR diagnostic criteria are of limited applicability in children because reliable anamnestic data are frequently lacking. Another problem in diagnosing Sjögren’s syndrome is the short-term detection of serological alterations and clinical symptoms. Even if young patients do not completely fulfill the required criteria, Sjögren’s syndrome can be assumed or confirmed in the presence of positive testing for oral and ocular manifestations and recurrent salivary gland enlargement.
Article
Background: Vitamin A deficiency with eye symptoms has been reported in patients with cystic fibrosis who received the recommended daily intake of vitamin A. Methods: We measured serum retinol, dark adaptation, contrast sensitivity, and dry eye status in 35 adult cystic fibrosis patients to ascertain whether they had ocular signs or symptoms. Results: Median serum retinol concentration was 1.95 mumol/l, range 1.08-4.01 mumol/l, with no values indicating vitamin A deficiency. Retinal light sensitivity was normal. Nineteen patients had reduced contrast sensitivity. Conjunctival imprints all showed plenty of goblet cells, but were characteristic of dry eye in 42% of patients (n = 14). Decreased tear film stability was found in 49% (n = 17), tear production was low in 31% (n = 11), and 23% (n = 8) showed an increased amount of dying epithelial cells. Nine patients (26%) had keratoconjunctivitis sicca according to the Copenhagen criteria. Conclusion: Our patients had no biochemical or clinical signs of vitamin A deficiency. We speculate that the high incidence of dry eye could be a primary manifestation of cystic fibrosis.
Article
Diabetic patients often complain of dry eye symptoms, such as burning and/or foreign body sensation. The aim of the present study was to investigate whether diabetes mellitus is correlated with tear film dysfunction and/or tear hyposecretion. In 86 consecutive insulin dependent diabetics with retinopathy and 84 non-diabetic controls (age and sex matched) we performed fluorophotometry of tear secretion, the Schirmer test, and impression cytology of the conjunctival epithelium and determined the tear film break up time. When compared with the healthy control group diabetics showed decreased Schirmer test readings (-37%, p <0.001) and significantly more frequent and pronounced signs of conjunctival metaplasia. None of the other values differed between groups. In insulin dependent diabetics, reflex tearing was demonstrated to be significantly decreased. In contrast, unstimulated basal tear flow and tear film break up time were found to be normal. However, a majority of insulin dependent diabetics shows distinct signs of conjunctival surface disease.
Article
The existence of 'fat-soluble A' has been known for over 80 years. But until recently clinicians were almost wholly absorbed by the ocular changes accompanying deficiency (xerophthalmia), and scientists with the vitamin's metabolic role in the rhodopsin cycle. The past two decades have witnessed a revolution in clinical and scientific concerns. Xerophthalmia is now recognized as a late manifestation of severe deficiency rather than of early, mild deficiency; as the mechanism responsible for half or more of all measles-associated blindness; and as the cause of half a million or more cases of pediatric blindness worldwide. Milder deficiency increases the severity of infectious morbidity, exacerbates iron deficiency anemia, retards growth, and is responsible for one to three million childhood deaths each year. Scientists are now busy unraveling vitamin A-dependent gene regulation to explain the myriad manifestations accompanying deficiency, while clinicians are designing and supervising programs to improve vitamin A status in over 60 countries, up from only three countries two decades ago. Control of vitamin A deficiency is now a major health challenge and goal of both UNICEF and the World Health Organization (WHO). Reaching that goal requires better parameters for assessing vitamin A status, increased understanding of metabolic pathways responsible for corneal dissolution (keratomalacia) and the molecular and cellular basis by which vitamin A status mediates resistance to infection. These issues are detailed elsewhere (Sommer and West, 1996).
Article
A 15-year-old girl with familial dysautonomia had acute corneal ulcerations while on a respiratory during a dysautonomic crisis. Within 18 days she developed irritating corneal ring calcifications. Subsequent corneal perforation in the left eye was treated successfully with a lamellar graft, followed later by a penetrating graft in the right eye under local anesthesia. Four days postoperatively, the patient died during a vomiting crisis. Neuropathologic studies showed marked cell reduction in the superior cervical and trigeminal ganglia, but slight in the ciliary. The foveas appeared immature and macular ganglion cells were mildly reduced. The corneal button and lamellar grafted cornea had severe thinning and superficial calcification. Keratoplasty in familial dysautonomia is considered hazardous because of the continual threat of vomiting crises, but with sufficient care may be worthwhile for corneal perforation or advanced corneal scarring.
Article
The Riley-Day syndrome is characterized by a dysfunction of the autonomous nervous system, sensory disturbances, neurological disorders, psychical anomalies and important ophthalmological symptoms, such as absence of tears, corneal anaesthesia, keratinized conjunctiva and cornea; myosis after instillation of methacholine. The diagnosis is based on the absence of fungiform papillae of the tongue and the absence of reaction after intradermic injection of histamine. The inheritance is autosomal recessive. The disease results probably from an enzymatic insufficiency.
Article
A sixteen-year-old black male with congenital alacrima and deficient salivary secretion demonstrated evidence of keratoconjunctivitis sicca. The workup revealed elevated immunoglobulins and histologically normal lacrimal and salivary glands, but there was deposition of amyloid in the conjunctival stroma. The differential diagnosis of the dry eye is discussed.
Article
We describe a family with markedly deficient lacrimation from infancy and punctate corneal epithelial erosions. An autosomal dominant inheritance pattern is suggested. A hypoplasia of the lacrimal gland in this family was suggested by pharmacologic testing and by histopathologic examination of the lacrimal gland of the proposita. The family investigated in this report represents the first instance of hereditary congenital alacrima without associated ocular or adnexal abnormalities and apart from systemic disorders such as the Riley-Day syndrome and anhidrotic ectodermal dysplasia.
Article
A child is reported with adrenocortical unresponsiveness to ACTH and autonomic dysfunction. The latter consisted of cold extremities, progressive loss of tear production, the development of achalasia of the esophagus, pupillary dysfunction, and an abnormal histamine skin test. These findings suggest progressive parasympathetic denervation as a cause for the adrenocortical abnormality.
Article
Knowledge of the ocular side effects of oral retinoids is important when treating patients with these drugs. The side effects include blepharoconjunctivitis, dry eye syndrome, cutaneous photosensitivity, contact lens intolerance, refractive changes, papilledema and pseudotumor cerebri, corneal opacities, and abnormal retinal function. The signs, symptoms, and management of these ophthalmologic effects are discussed.
Article
The authors studied the histopathologic, ultrastructural, and immunopathologic characteristics of conjunctiva from patients with Stevens-Johnson syndrome (SJS). A small subset of SJS patients with recurrent conjunctival inflammation unassociated with external factors such as lid margin keratinization, sicca syndrome, trichiasis, or entropion was identified. The ultrastructural and immunopathologic characteristics of the conjunctiva from these patients were distinctly different from those of the conjunctiva from SJS patients without recurrent conjunctivitis, and suggested an active, immunologically mediated inflammation. Vasculitis or perivasculitis, immunoreactant deposition in vessel walls, vascular basement membrane disruption, thickening, and reduplication, and a preponderance of helper T-lymphocytes, macrophages, and Langerhans' cells were the notable distinguishing features in those patients with recurrent conjunctival inflammation. This rare clinical syndrome may represent the ocular counterpart to recurrent dermal or oral mucosal erythema multiforme.
Article
To describe the clinical characteristics of juvenile Sjögren's syndrome (JSS) and report 5 new primary cases. Patients with SS whose disease began before age 16 were identified from a cohort study on SS. Previous patients with JSS published from 1952 to 1993 were found by literature review. Thirty-nine adult patients with primary SS were selected as a control group. Five patients with primary JSS were identified and described. Thirty-four published primary JSS were reviewed. Altogether, there were 30 girls (77%). The mean age at onset was 7.8 +/- 4 years. Parotitis was the most common first symptom. An extraglandular manifestation (EGM) was the presenting feature in 9.3% of cases. Rheumatoid factor (RF) was positive in 71% and antinuclear antibodies (ANA) in 67%. During the course of disease, at least one EGM was noted in 20 cases (51%). Leukopenia was the most frequent of these (7/20, 35%). HLA-DR3 was observed in 4 of 6 cases in which HLA typing was done. Compared with adult primary SS, parotitis at onset was more frequent in children (62.5 vs 13%). The frequency of ANA and articular manifestations were higher in adults (67 vs 92%, and 15.4 vs 38.5%, respectively). We reviewed 31 cases of secondary JSS, of which the most common associated autoimmune disease was juvenile rheumatoid arthritis (42%). JSS preceded by years the associated autoimmune disease in nearly 50% of cases. JSS may be a common disease. Parotitis and the presence of RF and ANA are the main features at onset. Characteristics similar to those seen in adults are observed in children. Long-term followup is needed to assess outcome associated factors.
Article
The authors' clinical experience has suggested that there is a form of dry eye with only decreased tear break-up time, which is associated with allergic conjunctivitis. The current study was performed to verify this hypothesis. The authors recruited patients with two types of dry eye syndrome, those with only decreased tear break-up (BUT type) and those with positive vital staining (staining type). Individuals without any symptoms or signs served as controls. All subjects were compared regarding symptoms, Schirmer and tear clearance test results, conjunctival papillary formation, antigen-specific serum-IgE level (s-IgE), and goblet cell density of the palpebral conjunctiva. Antigen-induced allergic conjunctivitis was produced in guinea pigs, and histopathologic changes of the conjunctiva were examined. Patients with the BUT-type dry eye syndrome were younger and their symptoms were as severe as the staining type. The Schirmer and tear clearance test results were better, and the papillary formation and s-IgE were observed more than in the BUT type. The average goblet cell density in the BUT-type syndrome was 625.4 +/- 193.2/mm2, which was significantly less than 1005.6 +/- 294.5/mm2 in the controls (P < 0.01). The average goblet cell density was significantly decreased in the allergic animals (10.40 +/- 1.11/0.2 mm) compared with that of the controls (16.21 +/- 0.26/0.2 mm) or the anti-allergic drug-treated group (13.69 +/- 0.30/0.2 mm) (P < 0.01). These results support the authors' hypothesis that decreased break-up time is in part associated with the decreased goblet cell density caused by allergic conjunctivitis.
Article
Epithelial permeability and autofluorescence of the cornea were determined by fluorophotometry in 21 patients with open-angle glaucoma or ocular hypertension using timolol medication with the preservative benzalkonium chloride (BAC) and 2 weeks after changing to timolol medication without BAC. The investigation was performed to determine whether removal of BAC would reduce toxic effects on the cornea and complaints of sensations of burning or dry eye. Corneal epithelial permeability decreased significantly after changing medication (mean decrease per patient 27%, P = 0.025). Corneal autofluorescence increased significantly after changing medication suggesting an alteration in corneal metabolism (mean increase per patient 6%, P = 0.003). Timolol without BAC was found to be as effective as timolol with BAC in reducing intraocular pressure (P = 0.4). Removal of BAC from timolol resulted in an improvement of corneal epithelial barrier function and in a reduction of complaints. The improvement was found to be proportional to the duration of the preceding BAC-containing therapy.
Article
Neonatal lupus erythematosus (NLE) is an autoimmune disease whose major findings are subacute cutaneous lupus erythematosus (SCLE) skin lesions and congenital heart block. Babies have maternal anti-Ro/SSA, anti-La/SSB, or anti-U1RNP autoantibodies. Anti-Ro/SSA are the predominant autoantibodies, having been found in about 95% of cases. The autoantibodies pass through the placenta from mother to child. Skin disease resolves at about the time that maternal autoantibodies can no longer be detected in the baby. NLE therefore provides the strongest clinical evidence that autoantibodies are involved in at least some manifestations of lupus erythematosus, but there is as yet no definitive evidence implicating autoantibodies in the disease process. Skin disease usually begins after birth, is transient, and does not result in scarring. Cardiac disease begins in utero, and the heart block is almost always permanent. Many babies require pacemakers, and about 10% die from complications related to cardiac disease. In some cases, transient liver disease or thrombocytopenia have been observed. Individuals who had NLE usually have healthy childhoods but may develop autoimmune disease in adulthood. Whether the later development of autoimmune disease is a common or an unusual event is not yet known. Mothers of babies with NLE may be asymptomatic initially, but with time usually develop symptoms of autoimmune disease. The most typical constellation of symptoms in our group of approximately 30 mothers of babies with NLE is that of Sjögren's syndrome. Most babies exposed to anti-Ro/SSA autoantibodies during gestation will not develop NLE. There is no test to determine prospectively which babies will be affected. Treatment during gestation is still controversial and, if attempted, should be reserved for fetuses with potentially life-threatening disease. Treatment after birth consists of topical management for skin disease and pacemaker implantation, if necessary, for heart block. Systemic steroids may be given for serious internal disease.
Article
Many Sjögren's syndrome patients complain primarily of dry eye. Epstein-Barr virus DNA has recently been found in the lacrimal glands of Sjögren's syndrome sufferers and normal individuals, and lacrimal glands are thought to be a target organ for latent Epstein-Barr virus infection. In this study, we performed lacrimal and salivary gland biopsies on 9 Sjögren's syndrome patients. Extracted Epstein-Barr virus DNA was assayed by polymerase chain reaction and compared to that of healthy individuals. An increased level of Epstein-Barr virus DNA was observed in all of the lacrimal glands and 8 of the 9 salivary glands from the Sjögren's syndrome patients. However, the amount of genome in the lacrimal gland was more than 10 times that in the salivary glands, not only in the Sjögren's syndrome patients but also in the controls. This may explain the pathogenesis of dry eye in patients with Sjögren's syndrome, and why the lacrimal gland tends to be so prominently affected. It may also suggest a therapeutic approach for this and possibly other types of dry eye.