In ophthalmology, those of us who treat children often share what we consider surprising anecdotes about kids with meibomian gland dysfunction. Maybe the child spends hour after hour using a tablet or computer, or maybe we can’t point to a specific cause. One thing we do know is that we’re seeing more and more children with this condition, which we long associated with middle and older age.
MGD causes glands to atrophy over time, which makes it very disquieting to find children are developing the condition. How can we preserve the long-term health of their meibomian glands? To answer this question, my colleagues and I first had to answer a more basic one: How prevalent is gland atrophy in pediatric patients?
The study: We looked specifically at gland atrophy, the most permanent and therefore distressing characteristic of MGD. For 99 patients ages 4 to 17 years with no history of dry eye or MGD, we performed meibography (LipiView, Johnson & Johnson Vision) and evaluated subjective symptoms using the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire. A masked rater graded images on a 5-point atrophy scale (0-4) and a 3-point scale for tortuosity (0-2). In both scales, lower numbers represent healthier glands and higher scores are less healthy.
The results: About 42% of the children had some degree of meibomian gland atrophy (mean score 0.58 ± 0.80 SD), and 37% had some gland tortuosity (mean score 0.45 ± 0.64 SD). We did not see any significant associations between atrophy and patient demographics; however, male patients had more gland tortuosity (P = .0124, odds ratio 3.36). SPEED scores showed that about 89% of patients were asymptomatic. The scores had no significant correlation with atrophy or tortuosity.
The implications: I think that most eye care practitioners do not expect meibomian gland atrophy and tortuosity to be common in children. Clearly they are. Some of the subjects even had moderate to severe atrophy. A problem for which we don’t routinely screen is affecting children, with permanent effects. What’s more, knowing this may alter the way we currently look at baseline gland architecture in adults.
Only by examining pediatric patients for MGD and atrophy can we treat the problem before dry eye symptoms or permanent damage develops. We selected meibography for this study because the current technology allows us to quickly and easily acquire high-quality images and identify atrophy and tortuosity. This may be a way forward to begin screening more patients for MGD, particularly children, before this chronic disease progresses.
Gupta PK, et al. Cornea. 2018;doi:10.1097/ICO.0000000000001476.
Disclosure: Gupta reports she is a consultant to Allergan, Alcon, Bio-Tissue, Johnson & Johnson Vision, NovaBay, Ocular Science, Shire and TearLab.