Dry eye child - still underdiagnosed and neglected by doctors

[littlemermaid]

For dry eye diagnosis in children, click link for article Eyeworld Cornea June 2013. Parents are usually the first to notice that children are blinking or rubbing the eyes more.

'There are rare diseases that might prompt tear film problems in children but ophthalmologists are more likely to see dry eye exacerbated by blepharitis, ocular rosacea, meibomian gland dysfunction (MGD), or an infection.'

'One of the most common reasons we see dry eye in children is due to either a Staph infection or Demodex blepharitis or related conditions' (Dr Esen Akpek). 'Some children get such thick oily discharge that the meibomian glands get clogged and need to be expressed.' (Dr David Granet)

Differential diagnoses include: allergy, chemotherapy or radiation, diabetes, juvenile arthritis, Sjogrens, other autoimmune and inflammatory conditions, vitamin A deficiency, Herpes or other infection, corneal dystrophies. 'We look at everything from their meibomian glands to allergic causes to infections to mechanical irritation' (Dr Granet) 'It is also important to rule out more severe corneal disease as a cause for the dry eye symptoms.'

For more information, search PubMed 'child blepharitis' or 'child dry eye'.

Br J Ophthalmol. 2012 Jul;96(7):949-55. doi: 10.1136/bjophthalmol-2011-300771. Epub 2012 Apr 13. Childhood blepharokeratoconjunctivitis: characterising a severe phenotype in white adolescents. Hamada S, Khan I, Denniston AK, Rauz S.
Br J Ophthalmol. 2005 Apr;89(4):400-3. Blepharokeratoconjunctivitis in children: diagnosis and treatment. Viswalingam M, Rauz S, Morlet N, Dart JK (free access)
Ophthalmology. 2007 Dec;114(12):2271-80. Visual outcome and corneal changes in children with chronic blepharokeratoconjunctivitis. Jones SM, Weinstein JM, Cumberland P, Klein N, Nischal KK.

'Dry eyes' in children has been highlighted as a research, clinical and funding priority by consultation between patients and medical professionals under the UK National Institute for Health Research, full report 'Sight loss and vision priority setting partnership: setting priorities for eye research' October 2013, p25 'Can severe ocular surface disease in children, such as blepharokeratoconjunctivitis and vernal keratoconjunctivitis be managed better?' http://www.sightlosspsp.org.uk/

This is progress For interested professionals worldwide http://wspos.org/

[wagnermid]

Thanks for that LM, it is useful information. I don't agree with the statement "parents aren't patient with doing a drops regime for a long time", for some of us it's a necessary part of life!! That's what my iPhone alarm is for, it goes off every hour!

[littlemermaid]

Hello, Wagnermid ~ Absolutely. Insulting, considering what we go through. Some thoughts do not transpose well through journalists though. I would not think he has many non-compliant parents, considering the costs of treatment. Maybe we don't know about his uninsured patients struggling to pay for eyedrops. It is very difficult to find doctors who know these conditions, isn't it. Hopefully he is one of our champions and pointing in the right direction.

It's good to see an article in 'mainstream' open access considering how many untrained eye professionals try to help or avoid children and babies. We need a lot more of this.

Rebecca's post made me smile: 'In a lot of cases the best recipe for getting on well with an MD is not expecting any of this part of dry eye care from them BUT finding opportunities to educate them about it so they can do a better job for the next person.' http://www.dryeyezone.com/talk/showt...6791#post86791

How are you guys? Are you putting in eyedrops through the night? There's work in US and UK on genetic testing and early-days on stem cell therapy.

[littlemermaid]

'Trends in the treatment of paediatric conjunctivitis', Rudolph Wagner MD, New York Sep 2013 http://video.healio.com/video/Trends...;Ophthalmology - common infections and antibiotics. 'Are we missing dry eye in kids' at 08:44. 'Children get rosacea too. Think MGD'

[littlemermaid]

'Are we missing dry eye in children?' EyeNet, AAO 2012 http://www.aao.org/publications/eyen...pediatrics.cfm Persistent eye trouble needs specialist investigation and support, preferably by paediatric ophthalmologists studying ocular surface or inflammatory disorders.

Unexpected, uninvestigated and unreported causes include genetic disorders, systemic and topical prescription medications (including hormone, steroid, antibiotic), viruses, and early autoimmune dysregulation, some with skin, joint and gastro signs.

Children's eye specialists may not have the training or interest in teamworking on whole-body disorders in the way that rheumatologists, ocular immunologists and genetic counsellors do. Managing the eye surface is sometimes not enough - not to investigate is a tragedy, and fails a vulnerable and trusting patient.

An interesting point at 08:45 'how many ophthalmologists here...' in this talk on investigating genetics for eye conditions 'Gene sequencing: when is a negative not a negative' by Hannah Scanga, Childrens, UPMC http://www.upmcphysicianresources.co...d-s-eye/item/3

[LaDiva]

My mother says when I was a baby that I had a rash around my eyes. The doctor thought it was eczema, and they took me off milk, and gave me soy. My eyes have bothered me all of my life, and I always thought I was tired or had allergies. One day, my eyes didn't hurt, and I realized that even though I'd only had six hours sleep, I wasn't tired at all. It was my eyes. My tear film didn't go bad until three or four years ago, so I've lived for years with some king of eye problem which was mild, but in the end, got very bad. What was wrong when I was a baby? Not sure which came first, the chicken or the egg. Interesting post Mermaid. Thanks!