Could my toddler have dry eyes?

[tiff]

My four year old son had an eye exam last year and everything was normal with the exception of a slight astigmatism in one eye. His eyes have visible red veins, which I always attributed to allergies (he has bad allergies and so does the rest of the family). Within the past year I've noticed him blinking strangely, kind of opening his eyes wide and then blinking a few times quite often each day. I've also caught him lick his finger and put it in the corner of his eye. When I ask him why he does this he says his eyes bother him, but never elaborates beyond that. He seems to have picked up on my eye problems even though I've done my best to shield him, so I don't know if that plays into all of this or not. Anyway, I plan to take him to my eye doc for an exam and wonder if any of you can comment whether he might have dry eye or if something else might be going on. thanks!

[Hopeful2]

Hi tiff,

He could certainly have dry eyes. Allergies run in my husbands family and my fourteen year old sometimes says her eyes are sore. Now that I think about it, I recall her being a toddler and complaining that the sun was too bright and that it hurt her eyes. I never made much of it, but now that I have dry eyes, I am thinking that she probably has some element of dry eye, maybe allergy induced.

On the other hand, it is possible that your son is reacting to your behaviour. Our children are very quick to notice when we are not well and when they are young, I think that 'role playing' could be their way of coming to terms with an parent's or sibling's illness. A colleague at work, has a young boy at home who has started complaining about leg pain and limping. The father had an accident about 8 months ago and is experiencing neuralgic pain at the sight of the injury.

Taking your little guy to the eye doctor for dry eye assessment sounds like a good idea!

[Shell]

Not sure I can help but

perhaps he has allergies (dust? pillows esp if they contain feathers etc so try allergenic ones), make sure his diet contains plenty of nuts (esp walnuts for the omega 3), fresh salmon, green veggies, bananas and that he is well hydrated. You could try something like Nordic Naturals as a supplement (they do fish oils esp for kids - try vitacost or iherb.com - iherb is better)... If you live in a 'dry' hotspot you could try running a humidifier in the house/ in his bedroom at night...

Supps: these look good (fish oil and borage oil for GLA) but are age five years up (see reviews though - it might be worth bearing in mind for when he turns five if this persists)
http://www.iherb.com/Nordic-Naturals...Gels/4199?at=0
In my opinion these ones (below) don't look so good (contain sugar as they're gummies) but I think they're all age:
http://www.iherb.com/Nordic-Naturals...ies/16472?at=0


Sorry I couldn't help more... Bless the little guy, it's bad enough for adults! I hope and pray he feels better soon! Keep us posted...

Shell (Ps if he's taking anti-histamines for his allergies, this can cause eye dryness as cab allergies themselves - annoying! - so it's worth trying all of the above I mentioned and cutting out high fructose stuff and packaged foods..eat as close to nature as possible!) Others here are great and should be able to give you valuable info too!

[tiff]

thanks so much to both of you. i will check out those links and order him something as soon as he turns 5. in the meantime it will be a few weeks before my eye doc can get him in, but i'll post an update on what the results are of his visit. he has been using veramyst nasal spray for allergies, has an air cleaner in his room, mattress and pillow protection, i dust like crazy, etc., so there is nothing else i can do on my own. but, i will look into altering his diet to include more omegas. what else helps with dry eyes in terms of nutrition? i have pretty bad dry eye and my doc never mentioned anything besides omega and flax. thanks so much!

[Shell]

Hi Tiff

Sounds like you're doing a lot right for your little boy

Here is a really good link I found helpful re diet (scroll down but the page has lots of useful info)
http://www.visionworksusa.com/dryeyes.htm

Do keep us updated I hope you and your little one find relief soon...

Diet-wise: do try to avoid anything unnecessary ie additives, artificial flavourings, colouring, anything with high fructose syrup. Try to cook as much as possible from scratch and focus on white meats, fish, veggies especially the green cruciferous ones, nuts, seeds, some fruit, avocados I've read bananas are good so maybe a small banana each day in his lunch box? If he has them, avoid sugary, fizzy drinks..

Just thought I'd mention: the link I posted earlier for the dry eye supplement says 5+ but I noticed some of the reviewers had given the capsules to younger children. Might be worth asking the specialist if he can start on the capsules early in his case...

Shell

[littlemermaid]

Hi Tiff,

I would access a paediatric anterior segment team at a big teaching hospital if you can, particularly for a child-friendly vision assessment (may be more appropriate techniques eg retinoscope/lens) and a better answer to the 'is it allergy or blepharitis or has he got vision/convergence issues?' question. If a doc says children don't get dry eyes you're in the wrong place.

If it's bleph they can fix it now. Maybe use warm water + cotton wool, or a warm wet flannel, as part of the bathtime hygiene routine, unless it worsens sensitivity, of course. You could check meibom now yourself if you're worried and can make it fun (!) - 2 fingers under the lower lash and very gentle pressure upwards. Look for tiny clear dots of oil along the lid margin. Make sure the ophth checks meibom anyway rather than just a cursory look in the slit lamp and tells you the difference between meibomitis and allergies, and condition of the tear film, any patchiness, and eye surface, checks under eyelids for allergy or inflammation signs. Report any lumps or bumps, chalazions, styes.

Allergy/hypersensitivity/diet precautions now sound like a good idea, as Hopeful2 and Shell, although I've done it surreptitiously by just not buying the junk. We're eating oily fish 3/week - salmon and mackerel - and reduced red meats and pork products and saturated fats to zero or minimum, cooking with light oils only, plenty raw fruit and veg, which young folks often prefer. (Bad fats and sugars are instant 3-4hr MG cloggers in LM's case. This is tough. It doesn't have to be eg zero sweets/candy or icecream or fries, small amount once a week alleviates the withdrawal symptoms. Obviously if you went very vegetarian you would rethink protein and vitamin nutrition. Just changing the overall habits in favour of producing good meibom oils and no metabolic inflammation/allergy eg no processed food or sugar drinks, use water + tiny bit of fruit juice concentrate. Eg children seem to like unskinned potatoes cut up, lightly tossed in small amount of oil and ovenbaked, good for many root veg. NB careful - we can't use the omega 3 oils this way because they change properties on heating. But some light oils, you can. Check the facts on different oils. Can also add some afterwards as a dressing.) Sounds as if you are already using minimum detergent for sensitive skin. Need to be super-careful about shampoos. Increasing humidity helps if it's tear film insufficiency. Also getting them used to wearing sunglasses in heat/wind. Although these environmental measures are not a fix, they can help restore eye surface health.

A paed ophth would be in case an adult service is unfamiliar with paediatric dry eye/allergy symptoms and assessment, or denies the existence of dry eye in paeds. This happens, don't get me started (!) The child eye surface behaves differently, prescription needs tailoring, maintaining it is a great skill. Certainly we have a very much more enjoyable experience in the paediatric service, especially for ongoing attention. I know you won't, but... I wouldn't be starting the consultation 'I've got dry eye myself and I just wondered...' I think he might get a fairer initial assessment, docs are only human and, personally, I avoid the overanxious mother tag, even though I am, and try to be as business-like as possible (unless you have something genetic, obviously it's good to mention allergy history). Especially since there Turned Out to be Something Wrong with my Daughter's Eyes Like I Said...

I'm guessing now, just from our personal experience. Vision changes fast while they are growing (a year is a long time in their time-scale), could need correction or amblyopia patching. Sometimes shows up at this age. Watch what he's doing when the discomfort happens, ask what he can see - eg TV, distance, handheld game console. Cover one eye to see if he's not happy. Rather than 'what can't you see?' compared to everyone else, which he wouldn't know, maybe try 'what can you see?' eg in the distance with each eye. Watch whether he's tracking OK or his eyes tire after a few pages when looking at books at normal reading distance. An optom would be checking the distance tracking, pupil reflex, visual fields, retinas etc for us too. Any observation you make is useful to them. The wet finger could be because of allergy itchiness. About this age, I started to notice tiny neuro-musculo-skeletal tics and details and wonder what they were. Nothing much, of course. Normally if it's tear film insufficiency from meibomian gland dysfunction, my daughter would be blinking and tearing more but closing her eyes against bright light, as Hopeful2, rather than opening and blinking.

Yes, we should be careful with our children's eyes and things do better when fixed early and he does deserve a proper assessment. Good luck finding good docs for a decent diagnosis.

[tiff]

This board is so incredibly helpful and comforting! Thank you all for your thoughtful responses.
I am taking my son to my eye doc tomorrow (he got us in in one day). I have no idea whether he has experience with children, but he's very good with my severe dry eyes and has been the only eye doc in our area that has had any idea what to do to help me. He also has the Tearlab device, which was hugely helpful for me. I'm unsure as to how to approach this. Littlemermad, I agree, I shouldn't say "I have eye issues and think he does too," but I'd like to make sure he examines him as fully as possible. Any suggestions on how I can do this in addition to just mentioning his symptoms? I'll report back tomorrow evening. thanks!

[Shell]

Hi Tiff

Just wanted to say that's great you got an appt. Hope you get some answers for your little boy and his eyes can be made much more comfortable. Don't know if you believe but I'll say a little prayer for your boy and will be thinking of you. Let us all know how he gets on!
Shell

[littlemermaid]

Hi Tiff, How about something like:
'We have a history of eye trouble in the family and, sadly, I'm wondering if he might be starting to suffer with his eyes too.
Fair and thorough assessment - I'm hoping he can be checked thoroughly at this age to see if we can catch any problems early on. [Paediatric ophth like this because this is one of their gripes that they can fix stuff early if the children get referred appropriately to them for early checks.]
Detailed observations - He's started rubbing his eyes and blinking differently and is obviously uncomfortable. We already know he has allergies[list them] and slight astigmatism but it would be a relief to know whether something else is going on. Especially whether he can still see well because his blinking has changed.
History - We all have allergies and I have very dry eyes now, so obviously it would be a huge relief to know there's nothing to worry about. I think he might need regular checks and advice on managing any signs of problems early since he seems to be uncomfortable. I would hate him to be overlooked or undiagnosed if there is anything he needs help with.'
Sometimes I go with 'I know it sounds/I don't want to be overanxious but..' to which the automatic reply is always 'no, no, of course you're not, you're right to ask/get it checked'. To get a thorough orthoptist check and to be taken seriously, there may have been occasions when I have, ahem, overemphasised certain (genuine) vision symptoms.

Sounds like you have a good relationship with your ophthalmologist and he does recognise dry eye symptoms despite the similarities. It is true these things start with small persistent signs (LM had tear spattering and photophobia to start with and it took a year to get an MGD observation diagnosis despite many many ophth examining her but hopefully those days are over for all of us). (I'm also thinking if he is atopic with allergy and the doc wants to 'try' drops, he needs to think twice and monitor it very carefully in case sensitivities develop on the eye surface and cause unwelcome changes. I so do not know what I'm talking about here but this is the direction research seems to be going.)

It would be great to hear what your ophth thinks and whether you agree. You are being such a fantastic mum noticing these signs and getting it checked out and he's a very lucky boy. Wish you all a great consultation, including your doc. Take a book for distraction while you're waiting! If the ophth isn't paediatric, maybe take a small distraction toy in your bag just in case he hasn't got the works, little wobbly finger puppet's a good one or some small character with a happy face.

[tiff]

So my son saw the doc today and one of his eyes has several blocked meibomian glands and the secretions from his glands are not ideal consistency, but rather thick and pasty. He also has some dryness in his eyes. The doc suggested we do blink tears once a day and a warm compress for five minutes each day and see him back in a few weeks to have a further vision exam (he seems farsighted) and see if anything improves with his MG.

I know many have children whose eye issues are far worse and so I don't mean to make a big deal out of this, but I'm worried and upset because he's only four. My eye problems are not good and I fear he's headed down my path of severe dry eye, MGD and other problems. How can artificial tears and warm compresses change the makeup of his gland secretions? I plan to modify his diet and hopefully that will help, but at the age of 4, it seems like nothing else can be done. I also worry that he's young to already have these problems.

I'd really love any thoughts or suggestions. I'm upset and super worried he'll not tolerate the drops. I use the same ones and so I told him we'll have our own special routine each night for only us, not his sister or his dad, but I can't imagine how he'll handle this and the compresses.

Thanks!

[Hopeful2]

Hi tiff,

Good for you for taking your son to the eye doctor! Did the doctor maybe suggest allergies? Do you think that maybe there might be some environmental issues that might be contributing or causing dry eye in your family?

I suspect there are environmental issues in my family. I am seriously thinking of dumping my front load washing machine because we are unable to get rid of the mold around the rubber seal and the drum. Our clothing and linen ends up holding the mold and then I think our eyes get exposed to it. Maybe there is something in your home that you are both reacting to?

[tiff]

Hi. He is on allergy medication already. The doctor didn't speculate on why ge had these issues, but I will ask at our next appointment. I tried to make putting the drops in tonight and he refused. I'm not sure what to get him to take the drops. Does anyone have suggestions? Also, how do we improve the consistency of his mg secretions?

I had no idea allergies cause dry eye. I've examined my house inside and out to eradicate allergens. If there is something here he is lucky because we are building a home in a new area. Hopefully that will help. In the meantime, I'm terribly worried about this.

Thanks everyone!

[Shell]

Thanks for keeping us updated

Sounds like you made some headway today

Here's hoping that the tears and compresses will help! Maybe you could try telling him the drops have special powers to make his eyes feel better but he has to be brave? Maybe the promise of a little reward if he allows you to do it? Maybe together you could design a little chart to plot his progress (say you want to use the drops 3 times a day, make 21 little stars with smiley faces and have a little tear by each of its eyes - stick one on his chart each time he does it and if he does it three times each day at the end of the day you could allow him a little treat, if he does it three times a day for a whole week he could earn a bigger treat... Kids love stuff like that and it should be a big incentive for him, along with lots of praise! If you can get it done once or twice it should be a lot easier for him to allow you to do it (when he sees it doesn't hurt)... As for improving MG secretions, I would honestly recommend the fish oils. You said he's on antihistamines - you do know that these dry the eyes out, or can? It might be worth trying a different antihistamine though I think they're all drying to some extent. Think about running a humidifier too

I don't want to frighten you or anything but have you considered having blood work done just to make sure it's not autoimmune... I may be way off track and I wouldn't want to panic you but is it worth a shot? It's just that an autoimmune condition causes my dry eye condition in main (plus I have ocular rosacea!)

Maybe best to see if the drops/ compresses help before doing anything else though - it might do the trick all alone! Did you ask about introducing the Nordic Natural children's fish oils?

Shell

[tiff]

I just have to repeat how comforting you all have been to me. I am so grateful for this board for both me and for my son.
Shell, great idea about asking the doc about Nordic Naturals. I'm going to ask at our visit in three weeks.
I'll try the incentive with my son and see if that helps. The drops are not painful at all, rather soothing I find, so hopefully he'll not have issues. I should add, he's the kind of kid who doesn't like water dripping in his eyes from the bath, so he's kind of sensitive.
The allergy med he's on is a nasal spray--veramyst. I am seeing our allergist in two weeks and will bring this up to him and have my son evaluated for another medication if his spray could pose any potential problem. His allergies have gotten worse, so I'm not sure we can forego treatment at all.
I had a host of bloodwork to try to find the source of my dry eyes and nothing came up. I speculated it could have been caused by a decade of birth control, but there's no way to be sure. I'm fair and have light eyes and my doc said people of Scottish and Irish descent (I'm part Scottish) have this more often. I've never heard that anywhere else though, so who knows.
I'm a little calmer now, thanks everyone!

[littlemermaid]

What a good eye doc. Eye treatment can be a pleasant, relaxing time with good attention at bedtime - LM's allowed on the big bed, lies in comfort, warm compress is timed, maybe with a fun timer at this age, chat/story/music. If you're using a flannel, prepare 2 or they don't last long enough. I have to say it feels like spa treatment... On the drops, they will go in on a closed eye if he's lying down, until he's happy taking them. They get used to people examining their eyes and quickly bunging various drops in the lower sac. I'm slightly wondering whether he actually needs much artificial tear and whether it's just the doc's standard treatment? How many a day? Maybe he will take him off it when he sees improvement.

The warmth melts congested oils in the eyelid glands, quickly relieves any blockages and as routine attention, prevents chalazion and styes. The consistency of meibom can be changed with diet and oils. I feel quite strongly at this point that it's important to avoid development of any further sensitivities around the eyes and surface changes from eye meds if possible so it's good to be vigilant. These clean eye measures will avoid infection and makes sure he doesn't need further intervention that might set up the sensitivities you are worried about. We ditched all bathtime products except basic soap and we were very careful when she was younger to use hypersensitive baby shampoo and not near the eyes. Humidifier is indeed a good idea. A little bleph is so very normal at this age and easy to fix. Children often get styes and chalazia, don't they. It is true that allergies can disappear in a different environment.