Clinicians may see dry eye in some adolescents and should monitor their meibomian glands for dropout and other signs of meibomian gland dysfunction, according to a study assessing expected values from common ocular surface diagnostic measures.
The cross-sectional study enrolled 225 participants between the ages of 8 and 17 years. They completed questionnaires evaluating dry eye symptoms and lifestyle, and tear film assessments and meibography were performed.
The purpose of the study was to provide expected values of the ocular surface and meibomian glands in children and adolescents.
“Our ultimate goal was to assess what the ocular surface looks like in patients in this age range who present to our clinics for eye examinations,” study author Anna A. Tichenor, OD, PhD, told Ocular Surgery News. “Historically we think of dry eye patients as postmenopausal women, but we have a lot more data now to suggest that dry eye could be occurring in younger patients, so we need to start screening our younger patients.”
Quantifying ocular surface values
Subjects were divided into groups based on age: 8- to 10-year-olds, 11- to 13-year-olds and 14- to 17-year-olds. They each completed SPEED, OSDI and modified SANDE questionnaires.
The average SPEED score was 4.3 ± 4.8, with 25% of subjects scoring above 6, which indicated mild or greater symptoms.
OSDI scores averaged 10.6 ± 12.1, with 27% of subjects having a score greater than 13, indicating possible mild dry eye, and 9% scoring greater than 33, indicating possible severe dry eye.
Thirty-eight subjects (17%) had a SPEED score greater than 6 and an OSDI score greater than 13.
SANDE severity score averaged 15.3 ± 19.4, and SANDE frequency score averaged 16.6 ± 20.5.
Adolescents report symptoms
Approximately 15% of adolescents had reported some type of symptom, with itching being the most reported, Tichenor said.
“It’s important to understand that kids may not know how to express that their eyes feel dry,” she said. “When we look at the ocular surface, we should look for signs of dryness in their eyes, even when they complain of a symptom like itching; we can’t just assume it’s allergies causing the itching. We have to do a full eye exam that includes looking at the structure and function of the meibomian glands.”
Of the 225 participants, 205 received meibography. A mean meibomian gland dropout percentage of 9.9% ± 8.8% was recorded in the upper eyelid, with 13 subjects showing a 25% dropout in the upper eyelid.
Lower eyelid meibography was performed on 218 subjects, and a mean meibomian gland dropout of 8.5% ± 10% was recorded. Ten subjects had a dropout greater than 25%.
“We found if we had only looked at one eyelid for dropout, we would miss the presence of dropout in the other eyelid, about 37% of those patients who were symptomatic,” Tichenor said. “We want to be screening both upper and lower eyelids for dropout, especially in pediatric patients where we can’t really rely on them to complain about dryness.”
No statistically significant correlation was found between meibomian gland dropout and electronic device or cosmetic use based on lifestyle questionnaires.
Based on these results, clinicians should be aware that dry eye and meibomian gland dropout are possibilities in adolescents.
“Clinicians should anticipate that approximately one in seven patients in this age range may be experiencing mild symptoms of ocular dryness without classical clinical signs,” the study authors wrote. – by Rebecca L. Forand
- Tichenor AA, et al. Cornea. 2019;doi:10.1097/ICO.0000000000002154.
- For more information:
- Anna A. Tichenor, OD, PhD, can be reached at Indiana University School of Optometry, 800 E. Atwater Ave., Bloomington, IN 47401; email: firstname.lastname@example.org.
Disclosure: Tichenor reports no relevant financial disclosures.